The difference between mediocre organizations and top performers are not the goals they set, but rather the accountability for achieving goals. As we work with organizations to help them improve the patient experience, we find that lack of accountability is the thing most likely to impede progress. If you want to demonstrate that being a patient centered organization is a top priority, much of the work is pretty straightforward. It usually involves the following:

• Setting clear, specific goals
• Communicating goals and progress on a regular basis
• Providing tools and processes to help staff acheive the goals
• Holding everyone accountable for results

Most organizations do well on the first three. But, it’s the accountability piece that can cause the service initiative to die a swift and tragic death.

Consider this unfortunately common example: Your organization establishes goals for patient satisfaction results based on a benchmarked survey. This allows you to compare your results with local and national peer groups. You communicate specific survey goals and emphasize that any results falling below a certain level will need to be addressed within a pre-determined timeframe, or some sanction will occur. You then train everyone on specific standards of behavior that should ensure consistency in the patient experience at every touch point in the organization. Then you begin measuring. You begin reviewing results. And you begin seeing that some results aren’t meeting those previously established thresholds. What happens next?

Often nothing.

It’s not uncommon for us to hear tales of lack of accountability throughout the organizations we work with – at least in the initial assessment. Interviews and focus groups with healthcare employees often reveal that it’s the lack of accountability that hinders the organization in making positive and sustainable change in the patient experience. Staff share stories of individuals who clearly do not live up to the standards, yet remain gainfully employed. They share examples of departments that have never taken steps to make improvements yet their leaders are not called on the carpet. The employees are keenly aware of this lack of accountability. In fact, they talk about it with each other. The upshot is a loss of credibility among the leaders who don’t take action.

Administrators know of these shortcomings as well. In fact, when we meet with them, 9 out of 10 times they will tell us that accountability is their greatest challenge. It’s not the planning. It’s not the goal setting. It’s not even the communication. It’s consistently and visibly holding everyone in the organization accountable to the established goals that drag them down. The dilemma is that leaders want to empower not babysit. And yet, if they don’t demonstrate vigilance, low performers will continue to fly under the radar but not unnoticed by their peers.

While we know this instinctively, accountability is often the hardest thing about leadership. We fall back on our seemingly innate tendency to ignore, delay or look the other way when it comes to addressing the lack of alignment between our stated goals and objectives and the actual behaviors that occur within our organizations. As leaders, we erode our own credibility when we fail to hold people accountable for actions and results. The same applies when we fail to recognize great work. Consider these questions:

• If I’m doing great work and consistently exceeding patient expectations, but nobody ever acknowledges the work I’m doing, how likely am I to continue in my efforts?
• If I’m not doing great work and consistently not meeting patient expectations, but nobody ever talks to me about my actions, how likely is it that I will continue along the same path?

We all know the answers, yet too often we persist in overlooking both the positive and the negative events that are shaping our organizations’ cultures. Lack of accountability causes exceptional employees to become disengaged or leave. Yet the marginally engaged employees stay, perpetuating mediocre service to patients. 

Healthcare leaders must step up to the plate to improve accountability if they want to create and sustain a patient-centered culture. Accountability starts and ends with you! How do you rate in the accountability area? The first step: diagnosing whether you suffer from the accountability failure disease. Here are four questions to do just that: 

1. Do you meet with your team members regularly to discuss goals and tactics for achieving goals?
2. When you observe, or hear about an employee that has gone above and beyond to exceed patient expectations, do you acknowledge that employee’s actions on the spot?
3. When you observe, or hear about an employee, that has failed to meet customer service standards, do you address that employee’s behavior?
4. Do you regularly make rounds and talk with employees about service goals?

This is a pass/fail assessment. If you said “no,” to even one of these questions, you have an accountability deficiency. The good news is – you can do something about it. Turning the corner on accountability is as easy as walking around, observing and commenting on what you see. When people see you showing up in their departments and taking an interest in what they are doing to achieve the goals, you send a strong message that service is a priority not just lip service. And that you will hold everyone accountable.