There are many issues of increasing importance within the healthcare industry; however, perhaps the most important in today’s day and age, aside from the question of insurance, is that of accountability within the field of healthcare. In order to more thoroughly investigate this matter, it is important to determine the reasons that accountability is necessary within the industry, how an employee’s accountability is measured, how it applies to the ethical considerations in leadership and management, what a checks and balances system looks like in a successful organization, how accountability affects the working culture of an organization, and how it may be possible to maintain a positive working culture as opposed to one centered around blame.
Accountability is concerned with three primary components: “1) the loci of accountability, 2) the domains of accountability, and 3) the procedures of accountability;” in other words, it is concerned with the people that may be held accountable, the areas of accountability, and the procedures to be followed for someone to be held accountable (Emanuel & Emanuel, 1996, p. 229). Accountability works to ensure that a party is able to not only justify their activities, but to take responsibility for them, thus ensuring that the party responsible is held to the highest standards, an essential practice given the fact that medical personnel hold the lives of others in their hands (Emanuel & Emanuel, 1996).
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Employee accountability is measured in a variety of ways; it may be formal or informal and it may be based on any one or more of the three dominant models of accountability: the professional model, the economic model, and/or the political model (Emanuel & Emanuel, 1996). The type and model of accountability used within the healthcare field will vary depending on the organization being reviewed (Tuohy, 2003). Initially the healthcare field was concerned with a trust based accountability system, with individuals trusting that their doctors were acting in their best interests and that if something were to arise that it would be the result of an accident (Tuohy, 2003). In today’s day and age, this mentality of accountability is unlikely to be found anywhere outside of a small town, and most times not even then due to the concerns regarding the fact that most healthcare professionals are seen as being more concerned with the money and with promoting the different drugs that they are affiliated with, or with overbilling health insurance as a means of obtaining additional funds; while not all healthcare professionals behave in this manner, they are tainted with the same brush. As a result of this and other factors, the different models of accountability were created in order to force accountability within the profession, as opposed to simply relying on the trust method of yesteryear (Tuohy, 2003; Emanuel & Emanuel, 1996).
Accountability applies to the ethical considerations in leadership and management based on the fact that accountability starts at the leadership and management level, ensuring the permanence of a form of accountability while at the same time making the entire unit or community within the healthcare organization accountable for their actions (O’Hagan & Persaud, 2009). Within a healthy, or successful, organization the system of checks and balances setup will vary slightly depending on the model of accountability that the organization has decided to implement, however, in spite of this, each will have certain similarities. A successful checks and balances system will start at the top, with each member of the board being held accountable by the other board members, the administrator being held accountable by the board, the department heads being held accountable by the administrator, the doctors and surgeons being held accountable by their department heads, and the nurses being held accountable by the doctors and surgeons. All personnel are held accountable by patients in their right to sue or to engage in mediation if they feel that they are being treated ill. In this manner, all individuals within the system are held accountable by someone, thus giving the appropriate checks and balances to the process.
Accountability affects the working culture of an organization in many different ways, the primary of which is that it works to ensure that the individuals within the organization are held responsible for their actions, thus making those individuals less likely to be negligent in their duties. The concern with a system of accountability is as a result of the fact that if implemented improperly instead of creating a positive working culture, a culture of blame will be created. In order to ensure that accountability is used to maintain a positive working environment as opposed to creating a culture of blame it is necessary for the organization to use accountability to improve performance, increase participation and involvement, increase competency, increase commitment, and drive morale higher; if the concept of accountability is simply used as a punishment, this cannot occur and a culture of blame will be created (Office of Personnel Management, 2014).
Accountability is essential to the healthcare field as it is structured in today’s day and age. By working to understand the reasons for its importance, how it is measured, the ethical considerations that must be taken into account, the checks and balances that must be created, and the working culture of the environment, it is possible to realize what a vital tool accountability is to success within the field in today’s day and age.
- Emanuel, E., & Emanuel, L. (1996). What is accountability in health care?. Annals Of Internal Medicine, 124(2), 229–239.
- O’Hagan, J., & Persaud, D. (2009). Creating a culture of accountability in health care. The Health Care Manager, 28(2), 124–133.
- Tuohy, C. (2003). Agency, contract, and governance: shifting shapes of accountability in the health care arena. Journal Of Health Politics, Policy And Law, 28(2-3), 195–216.
- U.S. Office of Personnel Management. (2014). Accountability Can Have Positive Results. Retrieved 23 October 2014, from http://www.opm.gov/
