In the healthcare industry, quality and performance ensures better outcomes for individuals. Efforts in healthcare to adopt and measure accountability have led to resource challenges, as the process takes times and prioritization, but the positive effects of accountability are undeniable. Organizations that adopt accountability measurements have improved work environments along with satisfied employees who can see their performance improve over time. Without accountability measures, performance is assumed rather than known.
Importance of Accountability
Improved quality of care and value of services are the primary reasons to have accountability. Measures lead to better care not only because employees are motivated to give better care but also because they learn where quality is lacking. This leads to purposeful change but also accountability that motivates those who may not have been inspired to perform.
Accountability also reduces the amount of misused resources by employees, which could make care more affordable. If resources are being misspent, accountability measures will detect that. Again, those that are aware of the measures may take more precaution with items that are disposable but cost the organization money.
Accountability aids in evidence-based research because the information gathered through accountability measures can inform further research endeavors. Employees are additionally encouraged to report errors and learn from errors in a culture that promotes accountability. Therefore, learning environments are created that can lead to less errors, which saves lives (O’Hagan & Persaud, 2009).
There are non-medical benefits to accountability in healthcare organizations as well. Employee satisfaction increases as employees become more responsible for the quality of their own work. Patients are also more satisfied with their care, and both groups’ satisfaction leads to less lawsuits. The results of accountability lead only to positive outcomes in care delivery.
The Joint Commission has created accountability or performance measures to make sure patients are getting evidence-based care. They admit that evidence-based care may not result is the best outcomes in every case, but many patients don’t get recommended treatments, and this has resulted in negative outcomes. The Joint Commission’s accountability measures have four criteria: research-based, delivery of evidence-based care, tied to improvement of outcomes and have intended results (Pronovost, Demski, Callender, Winner, Miller, Austin & Berenholtz, 2013). These can be applied to the benefits previously stated.
Performance indicators have been a challenge, and more research needs to be done in regard to data collection. However, the largest challenges still lie in mental health and health information systems (Smith, Mossialos & Papanicolas, 2008). These are relatively new factors in the medical system, and therefore performance measures are difficult to define.
Leadership and management must consider ethics when making change to organizations, and accountability fits ethical standards, as all ethical considerations must consider patient safety and quality care. Accountability reflects the ethical goals of improvement (O’Hagan & Persaud, 2009). Since it is ethical to provide quality care and ensure that employees are striving to give quality care, management must prioritize accountability.
The checks-and-balances process for a successful organization involves many external organizations that act as watchdogs. These organizations involve The Center for Medicare and Medicaid Services (CMS), Joint Commission, Quality and Patient Safety Organization and the Center for Disease Control among many others. In turn, hospitals and other medical organizations are performing internal audits using accountability measures such as those created by CMS and the Joint Commission. Accountability measures also inspire employees to motivate accountability. What results is a full circle of checks-and-balances that ensures quality actions at every level.
Effects of Accountability on Working Culture
The working culture of a health care facility is enhanced by accountability. It is not a culture of blame or fault-finding, although one of the expectations is to report errors in a way that can lead to future improvement. The working culture of an organization where accountability is prioritized leads to satisfaction among patients and employees, and they get and give quality services. The work culture benefits by the performance measurements because they see real performance measurements that lead to goal-setting and achievement. A culture that focuses on quality and measures quality also leads to a more professional environment where employees understand the importance of their duties and patients respect that they are getting the best services available. Accountability makes an outcomes-based culture that stresses quality but can celebrate performance.
Avoiding a Culture of Blame
To err is human, and no amount of accountability is going to prevent 100 percent of errors in health care. That is not to say it is not something to strive for. Six Sigma improvement aims for near 100 percent quality, but that is not what actually results when applying that strategy to health care. Instead of focusing on punitive reactions to errors, finding the source of the problem is a more effective prevention strategy. Those who have the errors will be less likely to hide them if in a culture where they get to be a part of the solution rather than simply punished like a child or a pet. This does not mean that purposeful acts do not go unpunished, but mistakes being what they are, future prevention is better than punishment and blame (Brewer, 2011). Avoiding a culture of blame results in less errors because stress and fear is lessened and replaced by a want to perform quality work.
Accountability is not a new idea, but accountability measures are a new standard in health care leading to benefits that save lives and lead to employee satisfaction. It inspires a professional and quality-driven culture that improves health outcomes for patients.
- Brewer, K. (2011). How a “just culture” can improve safety and health care. American Nurse Today 6(6). Retrieved from www.medscape.com/viewarticle/746089_2
- O’Hagan, J. & Persaud, D. (2009, April/June). Creating a culture of accountability in health care. The Health Care Manager 28 (2):124 – 133. Retrieved from www.nursingcenter.com/static?pageid=935642
- Pronovost, P.J., Demski, R., Callender, T., Winner, L., Miller, M., Austin, M., & Berenholtz, S.M. (2013, Dec.). Demonstrating high reliability on accountability measures at the Johns Hopkins Hospital. The Joint Commission Journal on Quality and Patient Safety 39(12). Retrieved from www.jointcommissison.org/assets/1/6/JQPS_12_13_Pronovost.pdf
- Smith, P.C., Mossialos, E., & Papanicolas, I. (2008, June). Performance measurement for health system improvement: experiences, challenges and prospects. World Health Organization: Health Systems, Health and Weath. Retrieved from www.who.int/management/district/perfromance/PerformanceMeasurementHealthSystemImprovement2.pdf