Held accountable: Making and keeping commitments

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Held accountable: Making and keeping commitments


After reading this article, you will be able to:

  • Identify how to communicate expectations for accountability during the hiring process

Nurse managers know that an environment in which staff members are accountable is one that fosters a high level of patient safety and care.

But it is more than a nurse manager’s responsibility to get staff members to meet the commitments to which they have agreed.

“We have to teach them and make sure they know the proper procedures and protocols that they’re supposed to be following, but after that, it’s innately them and their decision,” says Gayla J. Jackson, RN, BSN, nurse manager at Mount Auburn Hospital in Cambridge, MA.

Jackson acknowledges that it is as much a part of her job to make sure that her nurses are educated properly about hospital procedures as it is her nurses’ jobs to be accountable for their actions. Staff members who cut corners too often demonstrate a lack of accountability, she says.

Addressing accountability expectations early

Part of ensuring that staff members act accountably is making sure they have been given the appropriate tools to enable their actions.

Eileen L. Dohmann, MBA, RN, BSN, NEA-BC, vice president of nursing at Mary Washington Hospital in Fredericksburg, VA, sets expectations for accountability during the hiring process.

“We communicate what our expectations are and that we’re going to hold them accountable for those expectations,” Dohmann says.

During nursing orientation, she sets out hospital expectations and reinforces the notion of accountability by making sure each unit manager checks in with new hires and asks them to explain expectations to measure their understanding.

“One of the things I say over and over during nursing orientation is we have a rule as an organization—that [staff] are not to do anything anywhere in the organization unless they understand what they’re doing, why they’re doing it, and the impact it has on the world around them,” says Dohmann.

Julia E. Gabis, an attorney who has practiced in the healthcare field for almost 30 years, says it’s not just staff members who need to be educated about how to be accountable team members. Leadership teams need to be educated about how to address budding problems with a staff member before drastic action is needed.

“There needs to be a systematic, effective approach to dealing with concerns,” says Gabis, noting that she has too often represented physicians whose membership on the medical staff has been adversely affected before the hospital attempted a collegial approach to address concerns about conduct or competence. A more cooperative, less punitive approach can result in improved performance and substantial human and financial cost savings.

Patients can help with accountability

Although they are not trained like staff members, patients are an important part of any hospital dynamic.

Involving patients as much as possible in their care will force staff members to be more accountable for their actions.

“I teach people to be their own advocates,” says Trisha Torrey, a patient advocate who blogs and writes on the topic. Torrey, who teaches patients how to be “guerilla patients,” developed the term to encompass patients’ responsibility to ask questions of caregivers and ensure that they are getting the best possible care.


Adapted from Briefings on Patient Safety, December 2008, HCPro, Inc.