Examples such as this turn the spotlight on healthcare professionals. We are jointly accountable for the delivery of high-value healthcare, and are interdependent on each other in this regard. According to “The Oz Principle,” “when people view their accountability for results as something larger than doing their own jobs, they find themselves feeling accountable for things beyond what a literal interpretation of their job description may suggest.”
Don’t Be a Victim
The key to maintaining a future-oriented and proactive view of accountability (pushing us to consistently rise above our circumstances) is to not fall trap to becoming a victim. Connors and colleagues caution that when confronted with poor results and suboptimal performance, there is a natural temptation to make excuses, point fingers at others, create arguments for why we are not to blame, and otherwise rationalize why we are not accountable. Unfortunately, this attitude only perpetuates the myopically negative view of accountability “as a confession,” to be invoked to scrutinize, blame, or punish. A victimization mentality leads to the creation of cultures in which “saving face” is more important than solving problems, and, according to “The Oz Principle,” “quick fixes are favored over long-term solutions, immediate gains are favored over enduring progress, and process is favored over results.”
The danger of favoring process over results seems particularly germane to healthcare quality improvement (QI). In the complex, fast-moving, and pressurized environment of the hospital, it is easy to become satisfied with creating and deploying processes to address such issues as glycemic control, VTE prevention, or safe transitions of care. These processes are surely necessary, but they are certainly not sufficient.
Results are what we are aiming to achieve—not processes. In order to achieve results, the process must be actively managed, and the participants engaged in the processes must hold themselves─and each other─accountable for achieving the results that the processes are designed to effect.
Connors and colleagues write that “accountability for results rests at the very core of continuous improvement….The essence of these programs boils down to getting people to rise above their circumstances to do whatever it takes to get the results they want.” In order for HM to rise above current healthcare circumstances, we must never play the victim role. Blaming others will only keep us mired in current dysfunctional situations, preventing us from breaking free of untenable status quos that prohibit the delivery of high-quality and cost-effective patient care.
Conclusion
Accountability is difficult, especially for hospitalists. The time, though, is now for each of us to embrace accountability, because we will be expected to perform at increasingly higher levels of sophistication in the future. The first step to embracing accountability is to understand the concept, and in my next column, I will further describe concepts that demystify accountability by making it easier to apply in our everyday experiences.
Dr. Frost is president of SHM.