: required to explain actions or decisions to someone
: required to be responsible for something
Accountable… to give an account… to explain actions or results. Can we really ask front-line staff to explain (or be responsible) for system problems like emergency department waiting times? Can we ask front-line managers to be accountable for systemic problems?
When leaders throw out a solution, such as “we need more accountability,” how do we know that “lack of accountability” is really a root cause of the problem at hand?
Saying “we need more accountability” is sort of a polite coded way of saying “my people aren’t trying hard enough” or “my employees don’t care.” Those things are usually untrue, by the way. And these are awful things to say.
Instead of “more accountability,” we need to work together to improve the system that people are working in.
I think the list of things that people can “be held accountable for” is pretty limited. What are the things you really have control over? Maybe you can hold somebody accountable for showing up to work on time more often than not (although an unexpected system problem might occasionally interfere). If an employee is often five or ten minutes late to work because of traffic variation, they can be “held accountable” and they can take action to leave home earlier (even if that means arriving early some days).
But, looking at more complex situations, it’s harder to simply hold people accountable. When we blame and punish people for not hitting targets, senior leaders might think they are “holding people accountable.” Look at situations like the 4-hour A&E waiting targets in the British NHS. People get blamed and punished, so they end up gaming the numbers and distorting the system (by holding patients just outside A&E to prevent the clock from starting or by admitting them after 3:55).
Senior leaders need to help people improve the system, not just hold them accountable.
Why are there long waiting times in A&E or the ED? It’s often a systemic value stream problem that has root causes in outside agencies like long-term care or nursing homes not having enough capacity. This was a big problem when I worked with an Ontario hospital a few years back. The ED was all backed up. Why? Because they couldn’t discharge enough inpatients. Why? Because there weren’t enough long term care beds in the community. Why? Because of government budget constraints.
No amount of “accountability” or blame for the ED or the hospital is going to fix that problem.
I’d encourage you to try a similar exercise — when you hear people use the word “accountability” in your organization, ask them to step back and define what they mean exactly. Are they just blaming and punishing (or threatening)? Or, are they working to create a system in which people can choose to be accountable, working together to succeed instead of just making things look good?