How to Be Accountable in Hospital Medicine

In my last column, I outlined the “accountability imperative” facing the specialty of hospital medicine, and I discussed the need to hold ourselves accountable for delivering true, high-value healthcare. However, this is easier said than done; being accountable in the complex environments in which we work is difficult. The key to simplifying accountability rests in deconstructing the concept in a manner that allows us to consistently appeal to its fundamental tenets, so that applying these tenets in our everyday lives is easy. Understanding accountability begins with defining the term.

Accountability Defined

To be truly accountable, one must first appreciate what accountability is, and what it is not. This is beautifully articulated in a well-written book by Connors, Smith, and Hickman titled “The Oz Principle: Getting Results Through Individual and Organizational Accountability.”1 Connors and colleagues advise that we must conceive of accountability as forward-looking versus backward-looking judgment. All too often, society thinks of accountability as a historical or retrospective concept, that accountability is something to invoke when an individual has failed to meet expectations. Defining accountability in this manner casts the concept in a negative light by invoking fear and anxiety; accountability becomes synonymous with punishment, retribution, blame, humiliation, and scrutiny.

“The Oz Principle” suggests that “accountability is more than a confession,” and warns that people who narrowly define accountability in this manner become “obsessed with the past, and blissfully ignorant of the future.” This is sage advice for the profession of medicine. All too often, clinicians and healthcare professionals yearn for a past era in which it was supposedly easier to practice medicine because of independence from rules, regulations, protocols, pathways, performance measurement, and performance reporting. In lamenting the loss of a past era, people risk ignoring the present and thus fail to embrace healthcare reform initiatives that will soon establish new expectations. These new expectations must be met to ensure future success.

It behooves us─hospitalists─to define accountability in a more constructive and future-oriented manner. To this end, Connors and colleagues propose that accountability be conceived of as “a personal choice to rise above one’s circumstances and demonstrate ownership necessary for achieving results.” Such a definition empowers us to anticipate the future by acting proactively to avoid problems, rather than reactively, which forces us to explain why problems occurred. In so doing, we embrace our current situation, actively seek to understand new initiatives compelling us to alter our behavior, recognize the dangers in maintaining outdated status quos, and become actively engaged participants in obligatory change initiatives.

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