Importance of Accountability HCS/475 October 8, 2012 Accountability in Health Care Organizations In all industries accountability is important, however it is especially critical in health care, in which the livelihoods and lives of patients depends upon the correct actions of everyone that are involved. Mistakes can lead to inaccurate billing costs of thousands of dollars, or wrong treatments that lead to tragic injuries. Furthermore, as managed care becomes more complex, ensuring quality of care across an array of treatments, insurance companies, and providers becomes an increasingly demanding task, filled with risks of mistakes.

Accountability needs to be measured, maintained and tracked among health care employees in a manner that they commit to, rather than be taken away from the organization’s working skill, and center their attention on positive improvements rather than blame. Accountability itself is a somewhat an obscure concept. Depending on who is doing the investigating, organizations and individuals may exhibit many different kinds of accountability, all of which have some bearing on their ability to deliver appropriate health care services. Brinkerhoff, found three definite types and purposes of accountability: The ? st purpose is to control the abuse and misuse of public resources and/or authority. This relates directly to ? nancial accountability. ” The second is to provide support that resources are used and control is exercised according to the right and legal professional standards, procedures, and societal values. This is intended for all three types of accountability. The third type of accountability is to promote and support improved management and service delivery through feedback and learning; the focus here is primarily on performance accountability. Brinkerhoff, D. W. 2004. p. 374)’. Problems with accountability in health care usually come from the tendency of those in the health care culture to view responsibility–particularly physician responsibility–as individual rather than collective. Despite the fact that in a modern health care organization, everyone depends upon the efforts of everyone else, “as recently as 1984, a sociological study found that by and large, physicians and physicians-in-training continue to believe that they are answerable only to themselves (Sharpe 2000, p. 31)”.

This attitude subtly led to patient welfare being treated as secondary to professional reputation. Yet every physician depends on a complex system, and for genuine, continuous improvement in quality of health care to occur, this professional model of accountability must yield some authority to a model of collective responsibility. According to Von Thaden and Hoppes they describe this kind of collective responsibility as a Just Culture, and state that “a workplace devoted to Just Culture creates an active learning environment (von Thaden, T.

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L. and Hoppes, M. 2005, p. 1)”. Such a culture avoids blame and accusation through fostering an atmosphere of trust, encouraging learning from mistakes, and rewarding the sharing of information. An organization embracing a Just Culture cultivates a system of checks and balances in which all contribute to the overall quality of the service. “In medicine today, the potential to influence quality extends far beyond individual conduct to the design and functioning of systems, policies and processes (Sharpe 2000, p. 2)”. Such suitable designed systems diminish the negative aspects according to Emanuel and Emanuel call the political model of accountability; in “such a model, heath care is treated as a community good, and “voice” (the ability of patients, employees, and others to voice concerns, desires and complaints have those desires addressed) is the dominant procedure of accountability (Emanuel, E. J. , & Emanuel, L. L. 1997)”.

Emanuel and Emanuel have noticed that the political model of accountability has many disadvantages, that including “inefficiency in decision making, capture by extremists or experts, intractable value conflicts, fragmentation of community, and oppression of minorities (Emanuel, E. J. , & Emanuel, L. L. 1997)”, however those disadvantages can be fixed for by proper systems, and the political model can make sure that the tough distribution decisions are acknowledge and improve health through changes in nonmedical aspects of community life (p. 147).

To put it simply, when communication is done correctly and often between staff members within any organization it will pretty much guarantee accountability, quality improvements and encourages progress, and nullifies the culture of blame. Accountability within a health care organization is ensured in a number of ways. “The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) evaluates and accredits thousands of health care programs across the United States, ensuring that organizations adhere to appropriate standards and are able to track their own performance through customized performance measures (Darby 1998, p. 47)”. For physicians, the AMA has developed the American Medical Accreditation Program to establish a universally accepted process for certifying physician quality. Individual organizations may establish their own methods of tracking accountability as well, although these should not conflict with the methods of larger, well-accepted certifying bodies lest they inadvertently create a system in which the doctors are only accountable to themselves. There is no perfect system for ensuring accountability, for, as Mulgan discovered, accountability is a “complex and chameleon-like term” (Mulgan, R. 001)”, and our understanding of it as it applies to health care continues to evolve. While some accountability systems need to be in place, flexibility is necessary for continued communication and quality improvement. An organizational culture that encourages dialog and gives voice to all members creates accountability that is productive, dynamic, and free of blame. References Brinkerhoff, D. W. (2004). Accountability and health systems: toward conceptual clarity and policy relevance. Health Policy and Planning, 19, 6, 371-379. Retrieved from http://heapol. oxfordjournals. org/content/19/6/371. hort Darby, M. (1998). Health care quality: from data to accountability. Academic Medicine: Journal of the Association of American Medical Colleges, 73, 8, 843-53. Retrieved from http://www. nhpf. org/library/background-papers/bp_100_hcdata_2-98. pdf Emanuel, E. J. , & Emanuel, L. L. (1997). Preserving community in health care. Journal of Health Politics, Policy and Law, 22, 1, 147-84. Retrieved from https://www. ethicshare. org/node/425015 Mulgan, R. (April 01, 2001). “Accountability”: an ever-expanding concept?. Public Administration, 78, 555–73. Retrieved from ttp://eprints. qut. edu. au/9473/1/9473. pdf Sharpe, V. A. (2000). Behind closed doors: accountability and responsibility in patient care. The Journal of Medicine and Philosophy, 25, 1, 28-47. Retrieved from http://jmp. oxfordjournals. org/content/25/1/28. abstract von Thaden, T. L. and Hoppes, M. (2005). Measuring a just culture in healthcare professionals: Initial survey results. Safety Across High-Consequence Industries Conference. St. Louis, MO. Retrieved from http://www. humanfactors. illinois. edu/Reports&PapersPDFs/miscconf/vonhop05. pdf


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