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“Accountability is supposed to improve productivity by tracking performance. Up to a point, like most well-intentioned management expectations, this one may have the desired effect. In the long run, however, there could hardly be a more inhibiting practice. When made a fetish, accountability stifles creativity. Far from making employees perform better long term, accountability encourages a culture of evasion, denial, and finger pointing.”

–Richard Farson and Ralph Keyes, The Innovation Paradox

Chapter Goals

  • Describe the three levels of the accountability continuum, what you can and cannot hold people accountable for, and the downside of fostering a culture of hierarchical accountability.

  • Describe six reasons why a culture that relies on hierarchical accountability for performance management will inevitably underperform.

  • Explain why healthcare organizations should transition from a culture of accountability to a Culture of Ownership.

No one ever changes the oil in a rental car. Most people return the car with a full gas tank because doing so is specified in the contract—they are accountable for it. But no one washes and waxes the car or checks the transmission fluid because no one feels pride of ownership in a car that belongs to a faceless corporation. When you move from a culture of mere accountability to a Culture of Ownership, you create a sustainable source of competitive advantage for both recruiting and retaining great people and for earning long-term patient loyalty.

Accountability is doing what you are supposed to do because someone else expects it of you; it springs from the extrinsic motivation of reward and punishment. Neither of us have ever heard anyone complain that “no one ever holds me accountable”—it is always perceived as something that is done to you. Accountability is extrinsically imposed motivation—being answerable to someone else. Especially in healthcare, you cannot hold people accountable for the things that really matter; compassion, empathy, pride, loyalty, fellowship, and the other attributes of a great culture must come from within—they cannot be imposed with the carrots and sticks of accountability. An excessive focus on accountability also has a real downside. Trying to hold people accountable achieves only a short-term rise in results that quickly deteriorates into another “program of the month” that comes and goes without creating a sustained impact on the cultural DNA of the organization. The common understanding of “accountability” is that it is a liability to be held responsible and face the consequences for a failure of some sort. The most frequently used metaphor for holding a person accountable is “holding your feet to the fire”—a form of human torture that was perfected during the Middle Ages.

An organization that seeks to promote accountability according to this definition will likely end up with a workplace where people do only the tasks that are listed in their job descriptions and never take initiative or go above and beyond the tasks they are being held accountable for. Perhaps ...

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