Shortfalls in quality of care and rising costs have resulted in a widespread interest in developing strategies that enhance the efficiency of health care delivery. The implementation of multidisciplinary integrative teams of providers is a popular quality improvement intervention designed to manage patients with chronic conditions. However, little attention has been paid to the work environment, which may facilitate organizational change success. Relational climate is a measure of the work environment that captures shared employee perceptions of interpersonal relationships including teamwork, conflict resolution and diversity acceptance. A strong relational climate may improve treatment design, care delivery and process evaluation, leading to better quality and lower costs. This dissertation contains three chapters that seek to understand the influence of relational climate in primary care on quality and costs of diabetes care. Study 1, Relational Climate and Quality of Diabetes Care, measured quality of diabetes care using process-based and intermediate outcome indicators. It assessed whether relational climate was associated with quality of diabetes care. We used longitudinal data (2008– 2012) from the Veterans Health Administration. Multivariate regression analyses accounting for patient, clinic and parent facility characteristics suggested a positive association between relational climate and process-based indicators of diabetes quality of care. Study 2. Relational Climate and Costs of Diabetes Care, evaluated the association between relational climate and costs incurred by diabetic patients differentiating among outpatient, inpatient and total costs. It compared a Generalized Linear Model with the gamma distribution and the log link and a logged model with the Duan’s smearing adjustor. Cost models accounted for quality of diabetes care, besides other patient and clinic characteristics. Results indicated that relational climate contributes to lower outpatient and total costs. Study 3. The Indirect Association of Relational Climate and Costs through Quality, refines the cost-saving estimates of relational climate by accounting for the indirect influence of relational climate on costs through quality. The quality and the cost equations were estimated simultaneously within a treatment-effects model to account for selection bias in treatment compliance. We concluded that a stronger relational climate contributes to lower total costs. The results of this dissertation suggest that improving relational climate is a cost-effective intervention.

Thesis advisor: Janet E. Helms / Researchers have argued that whether Latina/o students and other students of Color resist their negative educational experiences with feelings of hopelessness or consider them challenges to overcome, depends on whether they have developed a Social Justice Orientation (SJO) (Cammarota, 2004; Diemer, 2009; Watts, Griffith, & Abdul-Adil, 1999). SJO is the motivation to promote justice and equality among all in society. The purpose of the present study was to develop and test a longitudinal model of predictors and outcomes of SJO among Latina/o youths, the SJOLY model. The constructs investigated were (a) environmental factors (i.e., school relational and language climates), (b) personal skills (English proficiency and Spanish language background) and characteristics (SJO and agency), and (c) social (i.e., community engagement) and academic outcomes (school behavioral disengagement, grades, and school dropout). The study was conducted with a subsample of Latinas/os taken from the National Educational Longitudinal Study of 1988. Participants were enrolled in eighth grade (N = 1,472), sampled from different schools and regions in the U.S., and followed through three waves of data collection until the 12th grade. The age range of the participants at Time 1 was 13 years to 16 years (M = 14.46, SD = .65), and 49.6% were girls. The SJOLY model was tested using structural equation modeling (SEM). Results indicated that school relational climate was a positive predictor of SJO, which in turn predicted more community and school engagement, higher grades, and decreased likelihood of dropping out of school via its impact on personal agency. In addition, school language climate and language skills predicted greater sense of personal agency, which in turn predicted higher grades and decreased likelihood of dropping out. Gender differences were observed, as more SJO was associated with higher levels of personal agency for girls, but not for boys. Higher levels of personal agency were associated with less likelihood of dropping out of schools for boys, but not for girls. Implications of the study results for education, counseling, and research are discussed. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental, and Educational Psychology.

This study developed and tested a contingency model of group communication in Korean workgroups that posited that the communication effectiveness and group performance of workgroups is determined by the “fit” of communication practices with organization structure and group relational climate. A contingency model incorporates three variables: contingency variables, response variables, and performance variables. Based on a review of the literature on Korean organizations and groups, the model incorporated two contingency variables: organizational structure and group relational climate. Organizational structure was indexed by the level of centralization and formalizations in the organization. Group relational climate was indexed by the level of closeness and group conformity among members. The response variables, communication practices of Korean workgroups, was measured in terms of the frequency of formal and informal meetings held by the workgroups. Two types of performance were measured: communication effectiveness and performance level. The contingency model hypothesized that the level of communication effectiveness and group performance of a workgroup that engages in communication practices which fit the requirements of organizational structure and group relational climate will be higher than that of a group whose communication practices do not fit the requirements of organizational structure and group relational climate. It also hypothesized the communication effectiveness group performance would be lower in groups which faced conflicting contingencies than in groups that faced consistent contingencies. A survey of 409 members of 84 workgroups in 37 Korean organizations was conducted. Results of this study supported the predictions of the contingency model. In particular, centralization, formalization, and closeness were significant contingency variables. The hypothesis regarding conflicting contingency was not supported. Implications of the study regarding the contingency theory, group communication and group effectiveness, and the nature of Korean groups and organizations are discussed.

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