In health care reform debates and planning discussions emphasize on making health institutions and physicians accountable for the patient outcomes (Brinkerhoff, 2003). Some of the challenges that the health care industry is facing are barriers to attain measurable and achievable procedures to maintain patients’ safety. It is therefore important to transform the prevailing medical culture so as to ensure that these institutions and physicians are held accountable for their patients’ safety. Accountability generally includes the processes and procedures designed to make an entity justify and be responsible for the activities taken (Brinkerhoff, 2003). All stakeholders in health care industry must account for all their activities as they try to achieve their goals. These include employers, management, insurers, and healthcare providers. Portery & Malloch (2010) point out that accountability is the most overused and misunderstood element of leadership today. Therefore, health care providers must strive to improve efficiency and quality in their institutions. This can be achieved by employing quality improvement initiatives and effective performance management systems. Accountability in health care industry can be measured in several ways (O'Hagan & Persaud, 2009). They include routine performance evaluations, customer satisfaction measures, employee assessment or appraisals as well as checks and balances.
Importance of Accountability in Health Care Industry
The central goal of creating and maintaining accountability culture in any institution is creating a continuously learning organization. O'Hagan & Persaud (2009) point out that it is very important to create and maintain an accountability culture since it is pivotal for an organization to achieve success, because accountability is the basis for measuring and improving performance.
The second reason why an accountability culture is important in health care is improving patients care quality and importance for money spent while receiving health care service (Sullivan, 2012). Increasing the responsibility of physicians and the involved management teams will also minimize misuse, overuse and underutilization of resources while reducing patients costs or tax payers. The patient care quality is improved through increasing the evidence-based medicine use as well as performance measurement targeted at reducing unsuitable care (O'Hagan & Persaud, 2009).
Portery & Malloch (2010) also highlight that ‘accountability encourages the assessment of evidence from process and outcome measures carried out routinely by relevant management teams. Supervisors or managers can use feedback from performance measurement to improve processes and outcomes of health care activities”. Finally, O'Hagan & Persaud (2009) add that accountability enhances learning behavior; thus reducing variability. This is based on the use of evidence-based protocols or practices, such as clinical practice guidelines (CPGs). According to O'Hagan & Persaud (2009), if the parties involved in healthcare demonstrate high levels of accountability, then there is an increase in the desire to make use of evidence-based practice during the provision of healthcare services. This will result in reduced variabilities in healhcare provision, which can be attributed to the culture that places emphasis on accountability.
How to Measure an Employees’ Accountability in the Health Care Industry
Employees’ accountability is a critical element of achieving goals in any institution (Portery & Malloch, 2010). According to O'Hagan & Persaud (2009), health care performance management systems are the foundation for measuring an employee's accountability. Employers use routine performance appraisal review as the primary tool to measure accountability (Brinkerhoff, 2003). Employees must be held accountable for performance standards of their respective institutions or the health care industry as a whole to improve employee engagement. The impact of employees’ accountability must also be factored in institutional philosophy. Harbour & Ball (2003) suggest that, clear direction, standards, regulations, performance accountability and an efficient work environment must be presented to employees for them to feel more engaged and accountable.
Performance standards used for annual reviews must be well-established and tested for efficiency (Portery & Malloch, 2010). Standards can predefine employees’ output levels aimed at achieving institutional goals morally. An example of a performance standard for a clinician could be requirement to visit a patient four times in a shift. Another example of performance standard in the health industry is attendance. Absenteeism must be formal and communicated in time at all costs. Performance standards are usually incorporated into an annual performance appraisal (Brinkerhoff, 2003).
Responsible management teams should also provide timely feedbacks to demonstrate their attention to employees’ performance. This acts as a channel of conveying messages that employees are being held accountable for performance standards and are acknowledged for important input into their institutional success (Portery & Malloch, 2010).
The Effect of Accountability on an Organization's Working Culture
Accountability can foster any organization’s working culture. This is based on accountability elements such as common vision, mission and belief (Harbour & Ball, 2003). Accountability culture spontaneously crops the desire and the need for continuous learning and improvement at personal or institutional level. Since accountability is tied to employees’ engagement, it ensures that resources are efficiently utilized while giving stakeholders maximum benefit (Portery & Malloch, 2010). Accountability also ensures that performance standards are established, and rewards can be based on this. Motivated employees perform well and this improves production. Accountability also leads to creation of strategies that can effectively handle challenges that emerge in the dynamic health care organizations (Brinkerhoff, 2003). These strategies can benefit health care providers and leaders in related fields to create a fair environment for all stakeholders of health care (O'Hagan & Persaud, 2009). Since accountability requires people to have ownership or control of their work, personal promises are made to achieve measurable work. For instance, an institutional CEO can be held accountable for improving the physician or staff morale.
How to Maintain a Positive Working Culture and Avoid a Working Culture of Blame
Issues such as defensive behaviors among employees, anti-learning culture, blame avoidance, infighting and the tendency to shift blame are some of the causes of dysfunction in health care industry. For instance, in Canada, provinces blame the central government for the lack of funding; the central government blames the provinces for mismanagement, while health institutions and local boards blame both (Harbour and Ball, 2003). Patients and health practitioners blame them both. Harbour & Ball (2003) suggest that all the parties involved in healthcare industry need to shift from the “blame game” to a culture of accountability and best practices in delivering high quality health care. Since this needs transformation of mindset to positive working culture, they outline six principles to maintain a working environment characterized by accountability as well as transformation of corporate governance in health care. These include: being accountable for things you have control over; activities/efforts or processes must be available and enough for tangible outcomes as well as real empowerment and room for personal discretion and judgment for results to be accountable. Harbour & Ball (2003) also highlight that accountability must be dynamic, subject to the fact that outcomes and targets change as circumstances change. They also add that a positive working culture should be tied to the observation that accountability and stewardship belong to every employee in any institution. Lastly, it is worth absorbing the fact that, for accountability to be meaningful and fair, appropriate consequences must be defined to all involved parties (Harbour & Ball, 2003).
All stakeholders involved in health care industry must conceptualize a performance management system and construct efficient performance appraisal methods to measure both individual and institutional accountability. It is very important that all levels of management embrace an accountability culture. Managers, front-line workers, supervisors and executive leaders should be accountable for their performance at all times. Mutuality is a critical success element in accountability processes that is effective and efficient. The health care system should therefore be shifted from deeply rooted hierarchical command-and-control structures, leadership styles, processes and systems.