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Importance of Accountability in Healthcare

The concept of accountability, although varying in definition from one setting to another, gains elevation in the healthcare industry as in other sectors. Presently, it can be conceptualized as “the obligation of individuals and agencies to provide information about, and/or justification for, their actions to other actors, along with the imposition of sanctions for failure to comply and/or engage in appropriate action” (Brinkerhoff, 2004: p. 372). There is consensus that improved accountability has becomes a central element to the improvement of the performance of the health care system. This paper examines the importance of accountability in the health care industry.

Importance of Accountability

Everywhere around the globe, governments and healthcare entities face pressure to provide efficient, equitable, and effective health services. Efforts to strengthen and reform health systems, thus realizing improvement, have adopted a wide range approaches that range from privatization to downsizing, citizen participation, increased competition and performance measurement just to mention but a few. A point of convergence of these approaches is the emphasis on accountability, which is now recognized as an integral element for implementation of health system performance and reform (Nurunnabi & Islam, 2012). The importance of accountability in healthcare can best be understood through examination of its essence in terms of answerability, which in every respect relates to the notion of transparency (Brinkerhoff, 2004). In this vein, accountability implies actors are obliged to explain and answer any questions concerning their actions and/or decisions. Thus, based on accountability, information can be provided relating to aspects like budgetary allocations and various activities as well as outputs whereby justifications and explanations are given.

As already mentioned, accountability drives the reform agenda in the healthcare industry. In many ways, this also relates to improved health system performance as would be achieved through sanctions that overseeing actors impose on accountable actors for any inappropriate behavior or action(s). These sanctions may constitute penalties, practice standards and requirements embodied in regulations, statutes, and laws. Equally captured in this context are the ideas underlying accountability such as reporting on, accounting for, mitigating, and explaining actions and, more importantly, taking responsibility for contextual outcomes. Hospital boards, managers, and other actors within the healthcare system remain accountable for their actions, which is a very important aspect of healthcare governance more so as far as the delivery of quality health care is concerned (Abor, 2015).

Measuring Employee Accountability in the Health Care Industry

Employee accountability in the healthcare industry is measured using quality indicators, which entail measuring the quality of services that employees provide (Forster & van Walraven, 2012). Conceptual quality indicators capture aspects such as patient-centeredness, safety, effectiveness, and timeliness just to mention but a few. The use of quality indicators, as explained by Forster and van Walraven, is premised on the fact that they statistically and conceptually reflect certain attributes of healthcare excellence. Given the role played by quality indicators in this respect, there is need for the health care sector to invest in research on the same so that performance and quality measures are as accurate as possible.

Accountability and Ethical Considerations in Leadership and Management

The nature of today’s business environment requires that leaders and managers make ethically appropriate decisions from time to time (Hsieh, 2017). Thus, in their capacity as ethical leaders (and managers), these actors are tasked with promoting, sustaining, and maintaining ethical behavior in the people they lead. Interest in ethics in the context of leadership and management has increased in recent times given the frequency and magnitude of scandals being witnessed (Ardelean, 2015). Indeed, given the volatile nature of the global economy, leaders and managers are, day in day out, confronted with complex situations and ethical dilemmas, a fact that elevates ethical decision-making as an integral element of leadership. It is in this regard that accountability emerges as a mechanism for promoting and enhancing ethical behavior within the organization. It equally applies to both leaders/managers and followers since, for the former, self-accountability ensures one is accountable to self, hence self-awareness even when others are not present. It creates a sense of responsibility and self-awareness more so when making decisions (Peloza et al., 2013). As to followers and other organizational members in general, accountability is an important construct for assessing beliefs, feelings, and actions, so that overall it is the basis upon which behavior and performance are monitored and evaluated.

Checks-and-balances Process in a Successful Organizations

With a system of checks and balances in place, an organization ensures not only shared responsibility but also the spread of power and control so that no one individual or departmental entity within the organizations enjoys absolute control and power. Thus, a successful organization would have a checks-and-balances process in which the concepts of responsibility and answerability apply equally across the organization, so that as each individual or departmental entity pursues specified goals and objectives, no absolute control and/or power is enjoyed, for instance over decisions. Everyone remains accountable so that at some point all decisions and actions must be explained and justified.

Accountability’s Effect on Working Culture

With the benefits and need for accountability clear, most organizations make efforts to build a culture rooted in accountability. However, staff longevity becomes a barrier since members of staff who have worked long enough in the organization tend to become rigid and unwilling to embrace change.  Furthermore, if employees are afraid that any mistakes made may potentially land them in trouble, they are highly likely to be display resistance to adoption of a culture of taking responsibility (hence accountability). In this regard, it is possible that if employee lack the resources then need to make optimal decisions and as such anticipate punishment in case they make poor decisions, a scenario arises whereby the organizations witnesses resistance to any efforts of initiatives geared towards enhancing accountability. While the benefits of accountability may be acknowledged by many in the organization, it may lead to a working culture characterized by rigidity to change as well as resentment to accountability initiatives for fear of being punished or sanctioned.

How to Maintain a Positive Working Culture

To maintain a positive working culture and avoid a culture of blame, the fear of being accountable and transparent should be confronted since it can be counterproductive and detrimental. It is imperative for organizations to critically analyze their current cultures and as such be able to determine what could be making employees not want or be willing to assume responsibility. As opposed to being risk-averse and taking a hardline punitive approach to dealing with emerging problems, organizations should seek alternatives that do not discourage accountability. Cultivating a culture of shared responsibility can go a long way in avoiding blame since everyone, be it management or subordinate, feels to be part of a whole so that while remaining accountable for individual decisions and actions, the sense of shared responsibility, success, and failure does not go away.