3 Conditions for Creating an Accountable Culture Within Your Healthcare Organization

If you've ever felt overwhelmed while trying to keep a pulse on all the moving parts of your health system, science has an explanation.
It's called complexity theory, and it defines complexity as a combination of:

1. The number of parts in a system.
2. The interrelatedness of those parts.
As you might guess, health systems tend toward extreme complexity. And you probably won't be surprised to learn that complex systems are notoriously difficult to predict, study, and manage.

It's Complicated

The complexity of our industry has skyrocketed in recent years as hospitals, health systems, physician groups, and payers have merged into ever-larger entities.
The impetus toward value-based care has also fostered complexity. When we talk about many touchstones of value —care coordination, population health, integration — we're basically talking about interrelatedness. To maximize value, the parts of our system need to work together more effectively.
Complexity has certainly changed my own work life. As a regional director for Vituity, I now oversee emergency medicine, urgent care, and skilled nursing practices on both coasts.
These teams are professionally and culturally diverse from one another. They work in different time zones. Each has unique needs and priorities. And it's my job to align toward client health systems’ and Vituity's goals.
So how do I hope to succeed? Well, given the increasing complexity of our healthcare organizations, I believe that developing a culture of accountability is essential for success.
In the remainder of this post, I'll try to paint a picture of what that culture looks like, why it matters, and what leaders can do to nurture it within their organizations.

A Leadership Imperative

Culture is the set of behaviors and beliefs that define business as usual at your organization.
My Vituity colleagues David Birdsall, MD, and Bonnie Carl, RN, frequently speak to healthcare leaders on the topic of leading culture change. Their overarching message: shaping organizational culture is one of the most mission critical leadership tasks you can accomplish.
Then there's accountability. The government now requires that hospital care meet certain cost and quality standards. Front-line professionals are increasingly being asked to demonstrate results, measure performance, and adhere to best practices.
The accountability movement can be a bitter pill for providers to swallow. Historically, we've been granted a certain autonomy and authority within our hospitals. But we're now living in a world where aligning with organizational goals is crucial to our survival.
So how can leaders foster a culture where accountability is considered business as usual? Here are three milestones we need to aim for.

1. A Sense of Common Purpose

The culture of accountability begins with everyone understanding and wholeheartedly accepting the organization’s shared mission. At Vituity, this means putting patients at the center of care and making decisions with their best interests in mind.
Keeping this shared mission in focus takes work. Left to their own devices, each specialty, each leader, and each project team will naturally prioritize their own agendas. It's up to leaders to:
  • Introduce the various players and clarify their roles.
  • Promote exchange of ideas.
  • Bring team members to the table when agendas collide.
  • Keep everyone apprised of team progress.
  • Reinforce the idea that we're all on the same team.
Studies show that high-performing companies embrace diversity and acknowledge talents of individuals who have conflicting objectives. By negotiating through our differences, our regional team evolves, and each group feels a greater responsibility for our overall success or failure.

2. Clear Communication

To foster accountability, leaders must communicate the guidelines by which our shared purpose will be accomplished. The acronym SMART is a great tool to use when setting goals with your team.
To be effective, a goal should be:
  • Specific. Clearly defining roles and responsibilities is mandatory. Concise expectations prevent ambiguity and decrease the risk of key initiatives being overlooked. 
  • Measurable. In defining progress and success, studies suggest that numeric measurements are most effective. Numbers tend to be natural motivators that foster ownership, create healthy competition, and focus the team on priorities. Periodically reviewing data together creates an opportunity to celebrate progress or problem-solve when change is needed.
  • Achievable. To foster success, carefully consider the team's abilities and the resources available.
  • Result-oriented. When setting goals with your team, keep your shared mission firmly in focus. Talk about the benefits you will achieve for your patients, colleagues, and hospital.
  • Time-bound. A reasonable deadline keeps all parties' eyes on the prize.

3. Ownership

Bonnie Carl likes to share a story about a county hospital with an underperforming ED. The supervisor let standards lapse and overlooked bad behavior. Over the years, nurses picked up bad habits.
When a new manager came in and demanded accountability, nurses departed in droves. The manager stuck to her guns. Three years later, the department was fully staffed with high performing nurses. Dozens more were on the waitlist to work there.
Which brings us to our third and final milestone. High-performing teams empower members through ownership, which fosters a culture of accountability.  
Being an owner is about standing by your commitment and recognizing that your results have a direct impact on the ability of others to meet their commitments.
Owners hold themselves and others responsible for results rather than waiting for directives from above. They recognize gaps in strategy and resources and take initiative to address them. Ownership sometimes means sacrificing one’s own agenda for the good of the organization.
If every team member embraces the concept of ownership, trust ensues, and the culture of accountability grows. In high-trust organizations, when challenges or unexpected issues arrive, the team comes together to find solution instead of playing the blame game.

Worth the Effort

A Culture of Accountability has a clear link to higher performance with the added bonus of improved competency, commitment, increased morale, and work satisfaction.  
As the experience of the county hospital demonstrates, high-performing professionals actually prefer environments where goals are clear and everyone is held to a certain standard. Shared purpose, defined goals, and ownership add meaning to our work and renew our sense of mission.
It's important to demand accountability as a leader, but know that a culture of accountability takes time to develop. Cultural change can't be achieved through orders and directives. It flourishes over time as your workforce experiences the rewards of a job well done.
If you are successful, a day will come when team members — and teams across the organization — hold one another accountable. And that's when the interrelatedness part of the complexity equation stops confounding your effort and starts working in your favor.