Finally, the use of quality indicators to promote increased accountability could lead to behaviours that do not translate into better care of patients. For example, the use of indicators to guide funding decisions could bias data capture by health care providers. Most quality indicators are derived from data based on subjective assessments.
For example, assigning diagnostic codes to hospital encounters relies on doctors documenting diagnoses and health records analysts assigning codes, and both of these processes are determined to a certain extent by subjective criteria.
Providers who are cognizant of the impact that coding has on indicator performance could ensure that data capture is conducted in a way likely to favour their institution. In fact, the results of several studies suggest that this phenomenon explains many improvements in indicator performance over time. Alternatively, undue pressure to achieve targets might make clinicians or administrators react in a way that could actually increase patient risk.
For example, hospital administrators might inadvertently put pressure on providers to prematurely discharge patients to avoid exceeding an arbitrary emergency department wait-time target. An administrator or clinician who lacks a holistic view of quality might feel that such decisions are justified, given the negative consequences for the institution associated with poor performance on the indicator.
Such actions would, paradoxically, adversely affect patient care in an effort to improve indicators designed to measure quality. For this reason, we suggest several actions. First, we need a better understanding of the limitations of current indicators. For example, it is necessary to determine how accurately statistics such as the HSMR or readmission rates classify the performance of organizations as high or low. Such analyses will maximize the fairness of any incentives and minimize the unintended consequences of the measure.
To achieve this goal, the health sector will need to make modest investments in research on quality indicators; this would cost significantly less than many other interventions in the health care system such as that for a new drug being added to provincial formularies.
To avoid perceived conflicts of interest, this investment should be directed toward experts who are able to critically assess quality indicators but are not themselves responsible for holding people accountable. Second, providers need to be fully engaged in the measurement, analysis, and interpretation of indicator data.
Providers know their business and should demonstrate the leadership required to measure its quality. Approaches in which governments and academics independently define standards are doomed to fail, as their understanding of what drives performance often does not take into account important nuances at the level of the individual patient, clinic, or hospital.
To achieve this goal, we recommend a gradual transition in funding methodology such that providers would be more accountable for their actual performance. Increasing the accountability of individuals who are responsible for care provision—and, therefore, their stewardship of resources—will likely increase their engagement in determining how they are actually monitored.
Although it is beyond the scope of this article to fully explore how to change funding methods, it is imperative to attain clarity in the question of specifically who is accountable to ensure fair and effective governance. Given that our current evaluation methods are likely inappropriate, the transition to new funding methods must be gradual. In addition, the changes will need to occur in tandem with training programs to teach the specific skills and knowledge related to performance management.
Third, the entire health care system needs to increase investment in performance measurement systems. The current approach—measuring what we can instead of what we should —is inadequate, especially in light of our large investments in health care services. Several thoughtful people and organizations have developed conceptual frameworks for measuring performance. They also include a requirement to accurately evaluate the costs of providing care at the level of the individual patient.
Rather than developing more frameworks or indicators per se, we should be investing more heavily in the infrastructure of measurement.
Specifically, funding should focus on electronic data systems designed to support clinical workflow, data systems to integrate the data derived from operational systems, and the training of highly qualified people who are able to analyze and interpret health care data.
Textbox 1 provides examples of how these investments could translate into more effective measures. Linking Accountability to Measures of Success But what really happens when performance on these measures falls below an acceptable level? Reinforcing Accountability How would you answer the following questions on behalf of your organization?
Does your organization define accountability for employees? If you surveyed your employees, would they be able to articulate the ways in which they personally meet or exceed the standards set by the organization or would there be a tendency to focus on organizational shortcomings?
Would employees understand accountability as the exclusive domain of managers who would tend to use it a punitive rather than supportive way? Do employees in your organization have ownership? When employees are sufficiently empowered, they think differently about their work and problems that they encounter when performing their duties and experience heightened levels of satisfaction and engagement when their efforts bear fruit for the organization and for themselves and their careers. Are leaders in your organization helping employees understand their purpose?
Of course people work for money, and there is ample evidence that they would prefer to earn that money working for a great manager, but meaningful work and the common cause behind it is important, too. Understanding and having a higher purpose can lead to increased levels of personal accountability, satisfaction, and engagement.
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An accountable workplace culture is one where employees can make decisions around their work. Ideally, these survey questions should reflect what you consider as accountable behavior — allowing your employees to understand what your organization values most. Whatever the reason may be, you have to address the issue as soon as possible. What do you think went wrong here? By adopting a mindset of curiosity — you can diffuse any tensions that might arise while addressing their mistakes.
Additionally, the employee can accept that they have made an error and would be able to fix it based on your feedback. As a manager, you should be kind and find the cause of their behavioral issues and offer solutions.
After speaking to them, you find out that they volunteer for a nonprofit organization after work hours and have to leave early to beat the traffic. You can then ask them to either come to work an hour earlier each day or work remotely over the weekend to submit their deliverables.
Use them to provide information and feedback to team members in order to achieve their set goals. Here are a few ways to share updates:. You and your staff can decrease errors and spend less time on documentation, allowing you to improve your accountability and reach goals as a team.
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How to Prepare for an Insurance Treatment Review. Clinical Director October has been a Registered Nurse for over 15 years. She is board certified in Mental Health and Psychiatric Nursing. She also graduated with bachelor and master degrees in Nursing from Western Governors University.
You must be logged in to post a comment. Log In. Why Is Accountability Important in Healthcare? How Is Accountability Measured? You might ask questions such as: Why are some tasks not completed? Are some activities not important to you? Are some activities too difficult to complete?
Did you set time aside to complete the task? Did something unexpected happen to prevent you from finishing an assignment? Accountability Best Practices There is a right way and wrong way to approach accountability. Here are a few best practices to keep in mind: Know the reasons: Make sure you and your clients understand your actions and the purpose of their treatment goals.
Consider your qualifications: Always ensure you're qualified and trained to provide a service your client requests before taking action.
Agree on treatment: Any steps you take to help your client should be part of an agreed-upon plan. Set clear boundaries: You may need to ensure your client understands your role by establishing clearly defined boundaries. Monitor and evaluate: Keep track of your client's progress, so you can identify issues early and make recommendations. Spend time periodically assessing the effectiveness of a client's current treatment plan. Help employees change: Make sure employees understand the importance of accountability in your practice and how it impacts patient care and your facility's success.
Encourage employees to share their thoughts and feelings. Make it easy: The concept of accountability can feel overwhelming to both clients and staff. Focus on changing one behavior at a time. Be honest: Part of accountability is being honest. Set an example by being honest if you make a mistake and encourage employees to do the same. How to Encourage Accountability If you wish to understand the psychology behind not taking responsibility, consider this study published in the Personality and Social Psychology Bulletin.
Begin With Collaboration Ensure clients understand that change happens internally and that you must work as a team to help them overcome difficulties and improve their behavior. Set Clear Expectations Setting clear expectations is an essential part of accountability.
Discuss Capabilities Clients can't reach goals if they do not have the skills or resources needed to complete certain activities. Determine How You'll Measure Progress You and your clients should set clear, measurable treatment goals and objectives together and agree on how you'll measure their progress. Give Feedback Continually check in with clients and discuss their thoughts and feelings about their therapy sessions.
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