Sorry for the longer than expected hiatus. I expected to get right back to blogging but getting classes up and running took more time and effort than I anticipated. Now, I need to switch topics for the next few blog posts. I want to write about accountability.
The word, “account” comes from a Middle English word meaning “to tell”. According to the New World Dictionary account can mean to consider or to judge to be (of some value), to deem, or to value. It also can mean a reckoning (often of money) received or paid out. Account likewise refers to worth or importance as “a thing of small account”. To be accountable is to be obliged to account for one’s acts, to be responsible. Accountability means capable of being accounted for, explainable.
Marcia Rachel (American Nurse Today, Volume 7 Number 3) in her article, titled, Accountability: A concept worth revisiting wrote the various definitions of accountability share common concepts such as obligation, willingness, ownership, and commitment.
Accountability implies legal responsibility in health care. Manuel and Crowe (2014) quote the U.K. Department of Health which declared that “…clinical accountability describes the potential for disciplinary action occurring if one fails to exercise their clinical responsibility”. The Department of Health’s linking of accountability and disciplinary action illustrates the previous definition of accountability as an obligation to account for one’s acts. Such a link requires visible evidence of one’s actions. Here we see a connection between accountancy and accountability. By that I mean nurses are obliged to turn their actions into ciphers, nursing must become “calculable”. Evidence that nurses have internalized this type of accountability can be heard in the frequent admonition, “If it wasn’t documented, it didn’t happen.”
High profile inquiries into unacceptable mortality rates and poor care in hospitals in some areas of the UK have drawn attention to what Walshe and Shortell (2013) describe as cultures of secrecy,self-protection, and institutional defensiveness. These inquiries found institutional cultures in which health care providers were focused on doing the business , rather than focusing on patients’ best interests (Francis, 2013) The report further recommended that those who care for patients should be properly accountable for what they do.
Manuel and Crowe (2014) note that inquiries into this type were prevalent during a time of advanced liberal political ethos in the late 20th,early 21st centuries. Other terms for this movement include Neo-Liberalism and Managerialsim. In this type of culture of defensiveness there tends to be a focus on accountability, who or what is responsible for poor outcomes of care and how can risk-management strategies be undertaken to prevent such outcomes. (Crowe and Carlyle, 2003).
In the next few blog posts I will be linking current understandings of risk-management and accountability to results of interviews with nurses who describe the effects of Hourly Rounding, and the increasing time requirements of documentation.
Crowe, M., & Carlyle, D. (2003). Deconstructing risk assessment and management in mental health nursing. Journal of advanced nursing, 43(1), 19-27.
Francis, R. (2013). Report of the Mid Staffordshire NHS foundation trust public inquiry: executive summary (Vol. 947). The Stationery Office.
Manuel, J., Crowe, M. (2014). Clinical responsibility, accountability, and risk aversion in mental health nursing: A descriptive, qualitative study. International Journal of Mental Health Nursing. (Vol. 23). 336-343. doi: 10.1111/imm,12063
Walshe, K., & Shortell, S. M. (2004). When things go wrong: how health care organizations deal with major failures. Health Affairs, 23(3), 103-111.