Creating a Culture of Accountability in Healthcare

A lack of accountability in healthcare can do significant damage. Here's how to create a culture of accountability in your healthcare organization.

December 22, 2020

Article highlights

In the healthcare industry, accountability is incredibly important.

A lack of accountability in healthcare can cause significant damage to your organization. It can erode quality of care, ruin your organization’s reputation, and increase the risk of lawsuits.

A lack of accountability can even put patients’ lives at risk. A study by the Journal of Patient Safety found that more than 210,000 hospital patients die each year from hospital-related infections or medical mistakes.

Many of those could have been avoided if staff followed proper policies and procedures.

A culture of accountability in healthcare can help prevent such mistakes. Accountability in healthcare includes clear policies and procedures, but it is about so much more than just telling employees to follow the rules.

Ethics and accountability should be an integral part of your organization’s culture.

When healthcare organizations hold themselves and their employees accountable, they can learn from mistakes and continuously improve operations. A culture of accountability in healthcare improves doctor-patient trust, reduces the misuse of resources, and helps organizations provide better quality care.

Here are a few ways to create a culture of accountability in healthcare:

Align Your Vision, Strategy, and Tactics

Workplace culture has everything to do with the organization’s underlying values. Therefore, it’s important for your healthcare organization to establish and regularly communicate core values.

Formalizing your values and mission can help you make sure your organization is moving in a positive direction. You can adapt your strategy and tactics to make sure your organization’s actions align with its mission and values.

It starts with leadership

A culture of accountability in healthcare has to start on a personal level. It has to start with you.

Personal accountability is important for staff on every level of the organization. But it’s especially important for leaders and managers to lead with honesty and integrity.

When leaders model accountability, transparency, and ethical behavior, lower-level employees often follow suit.

As Apple CEO Tim Cook told Fast Company, “Ultimately, it’s on the company leaders to set the tone. Not only the CEO but the leaders across the company. If you select them so carefully that they then hire the right people, it’s a nice self-fulfilling prophecy.”

Focus on a common purpose

People who choose a career in healthcare care about helping people. They want to deliver excellent patient care and help people improve their health.

Creating a culture of accountability in healthcare starts from those common values and motivations.


Rather than simply lecturing staff on following rules, talk about how accountability measures enable them to help patients more effectively. Stress your organization’s shared values, such as compassion, teamwork, and excellence.

Be aware of informal team norms

When attempting to create or strengthen a culture of accountability in healthcare, take note of the unspoken expectations and norms already in place in your organization.

For example, an article in the Harvard Business Review tells the story of how health insurance company Aetna shifted some of its unhealthy cultural norms.

In the early 2000s, Aetna was struggling, in large part because of a culture that “encouraged employees to be steadfast to the point that they’d become risk-averse, tolerant of mediocrity, and suspicious of outsiders.”

When John Rowe took over as CEO, he took the time to understand the underlying workplace culture. Then he set to work shifting unhealthy attitudes and reinforcing positive aspects of the culture.

The Business Review explains:

Without ever describing their efforts as “cultural change,” top management began with a few interventions. These interventions led to small but significant behavioral changes that, in turn, revitalized Aetna’s culture while preserving and championing its strengths.

By building on and shifting existing informal norms, Aetna leadership was able to move company in a more positive direction.

Encourage Clear and Open Communication

Transparency and clear communication is an essential aspect of creating a culture of accountability in healthcare.

Make culture a topic of conversation

In the above story about Aetna, the key to the company’s successful cultural shift involved employees in conversations about the strengths and weaknesses of the company culture.

As the Harvard Business Review tells it:

Rowe didn’t walk in with a new strategy and try to force a cultural shift to achieve it. Instead, right from the start, he … took time to visit the troops, understand their perspective, and involve them in the planning. With other members of the senior team, they sought out employees at all levels – those who were well connected, sensitive to the company culture, and widely respected – to get their input on the strategy as well as their views on both the design and execution of intended process changes.

This kind of honest discussion about culture makes employees feel respected and heard. It helps leaders identify ways to effectively improve accountability in healthcare and get staff buy-in to accountability measures.

Be willing to talk about errors and mistakes

Many healthcare organizations have an unspoken culture of fear and shame when it comes to medical errors.

For example, studies have shown that doctors are often hesitant to admit mistakes for fear of litigation or job repercussions. In this kind of environment, staff members fear that they will get blamed for any mistakes, so they simply don’t report errors.

In the past few years, many healthcare organizations have begun trying to shift this culture of blame to a culture of safety.

Nurse Sherry Shaffer Ratajczak, the clinical editor at Elsevier, says a deliberate cultural shift can improve accountability in healthcare.

“Many nurses fear that reporting a medication error will result in a loss of their job, or worse, a loss of their license,” she says. “However, in a culture of safety, institutions view errors as a systems issue and encourage nurses to report and discuss errors to improve patient care.”

Create Ethics Education and Training

Ethics are foundational to creating a culture of accountability in healthcare. And ethics education and training is especially important in the healthcare industry.

Ethics violations can not only damage your organization’s reputation, they can also put you at risk for litigation. Cases of fraud and abuse cost healthcare organizations billions of dollars each year.

Ethics education and training can help employees hold themselves and others accountable, and know when to speak up if they see another staff member doing something unethical.

Code of conduct training

Most healthcare organizations have a formal code of conduct. A code of conduct puts your organization’s ethics into a more concrete form, helping staff members see what behaviors are acceptable and what is unacceptable.

Many organizations only train staff members on the code of conduct during the onboarding process. But the code of conduct should be included in recurring staff training and testing. This helps ensure that staff follow best practices.

The code of conduct should cover things such as harassment, patient confidentiality, integrity with billing and finances, and much more.


Conflicts of interest

The Institute of Medicine defines a conflict of interest as “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.”

Conflicts of interest can be complicated, but it’s best for healthcare organizations to work hard to avoid even the appearance of impropriety.

For example, it could be a conflict of interest for an employee in purchasing accepts a gift from a vendor, as the gift may be seen as swaying the employee’s decision on which vendor to buy from.

As an earlier post pointed out, most ethics violations happen when employees are simply unaware of how the laws or rules apply in their position. So it is important to train employees on common ethical issues and provide them with concrete examples.

Establish Clear-Cut Expectations

In order for employees to be accountable, they must have clear guidelines and regulations to follow.

Healthcare organizations communicate these goals through an employee handbook outlining policies and procedures. Make sure every employee reads and signs off on policies and procedures.

But along with policies and procedures, a few other practices help ensure a culture of accountability in healthcare:

Goals, measuring, and tracking

In order to be held accountable, staff members need to know the standards they are being measured against. This includes tracking things like infection rates, patient satisfaction rates, and the timeliness of care.

Measuring processes and outcomes can help you identify what interventions work best for certain types of cases and see areas you can improve.

Be sure to make specific goals a part of your normal operations and regularly track and measure progress. Create incentives for staff to meet and surpass these goals.

Give everyone a sense of ownership/responsibility

A culture of accountability in healthcare works best when every staff member helps hold themselves and others accountable. In order for this to happen, your organization must make it clear that you value everyone’s opinion.

Employees are more likely to go above and beyond when they feel heard and empowered.

Create clear channels for employee feedback and reporting. This can help prevent a culture of silence where lower-level employees feel they are not allowed to question their superiors.

A study by Johns Hopkins found that patient safety dramatically improved when healthcare organizations allowed and encouraged nurses to question doctors who skipped a step or violated safety measures.

As you seek to create a culture of accountability in healthcare, remember to start by clearly articulating your organization’s vision and values.

Encourage transparency and open communication, train your staff on ethics issues and provide clear standards and expectations. These efforts will help your healthcare organization deliver better care to patients, avoid liability risks, and continually improve operations.

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