Date of Award


Degree Type


Degree Name

Doctor of Business Administration (DBA)



First Advisor

Dr. Patricia Ketsche

Second Advisor

Dr. Lars Mathiassen

Third Advisor

Dr. Dan Robey


The growing complexity of healthcare delivery coupled with the pressures to improve cost, quality, and outcomes has healthcare leaders struggling to prioritize initiatives and programs that provide coordinated patient-centered care. It is generally accepted and most academic studies demonstrate that better care coordination will reduce redundancies, improve clinical decision making and provide patients with better care experiences. Moreover, industry leaders are pushing for reforms and policy makers have regulated structural changes aimed at improving the US healthcare system. However, to implement such changes, healthcare organizations must understand the elements of care coordination at the work flow level and how those elements are impacted by the context in which the care is being delivered. Against that backdrop, this ethnographic research of a pediatric clinic designed as an Integrated Practice Unit as defined by Porter and Teisberg examines the care coordination activities between the providers to understand how they are carried out in this specific context, and how infrastructure changes such as the implementation of an enterprise Electronic Health Record impacts the everyday practices of care coordination. As a result, we contribute to the concept of an integrated practice unit by studying it in an operational context and through the lens of Relational Coordination Theory. We make observations regarding the extent to which integrated practice units enhance care coordination and patient value. We also contribute to Relational Coordination Theory itself by demonstrating how “non-core” team members, organizational context, and worker outcomes are observed so that these measures can be addressed quantitatively in the future.


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