Accountability - May 2024

Accountability - May 2024

The buck stops … where? The work has to get done but between task identification and final completion, it can feel like herding cats.

A common challenge in healthcare is getting people to do tasks that are important to you but not as urgent to the individuals you need it from. If you manage any area of compliance, you will need something from everyone, e.g., mandatory education completed, time cards submitted, health screenings done, safety/risk issues reported, etc. It’s easy for an employee to think, “That’s why we have a coordinator role for those things.” But there is nothing to coordinate if everyone doesn’t do their part.

When you hold yourself to a high standard of accountability, your stress may build when others don’t share that same standard. How do you move past frustration to get people to do what they are supposed to do, when they don’t necessarily want to do it?

  • Threaten them with termination? Not the place to start if you want engagement. Too often we start here with the “stick” approach, hoping fear will bring on compliance. The tricky part is that employees do need to know up front what accountabilities are non-negotiable, but starting with a threat doesn’t create a motivating environment.
  • Address inconsistency with peers. “I am holding my staff to the deadlines for these requirements.  They are reporting that you have told your staff that the deadlines are not important. This inconsistency makes it hard for me to get people to do things that they would rather not do anyway. I need your support; what actions will you take to address this?” You can offer to share how you have fostered accountability, but the other leader needs to know that inconsistency among leaders is a downward spiral for morale.
  • Update policies and procedures to be understandable and clear. Ask employees to help you write them so that they have a ground level understanding and can have input on if they make sense or not.
  • Have some fun. Engage a team to help come up with creative and fun ways to do those health screenings. Liven up mandatory education so that even if there is dreadful screen time that it includes a game, contest, food prizes, follow-up in-person discussions, etc.
  • Communicate. I know; your head may hurt from all the communication you believe you have done but it is human nature for people to wait for the WIIFM (What’s In It For Me) to kick in. Spend less energy on why they won’t comply and more on answering the questions on the minds of the people you want to engage:
    • WHAT? Just what is it you are asking people to do? People are smart about different things. We make assumptions that others understand all the things that we understand. Give more thought to how you explain what you want from people and the bottom-line target you are after. When you’ve done that, ask them for what they are taking from your request to make sure that the message was delivered and received as intended.
    • WHY? Appeal to the heart. I don’t like filling out forms any more than the next person. But if you can share a true story about how a child was saved in the OR because a housekeeper on staff reported a safety issue in that form, I’m going to remember that story every time I am reminded to fill it out myself. “It’s a required regulation” is not an inspirational motivator for everyone. Intrinsic motivation derives from connection to purpose.
    • HOW? More often than we want to admit, we ask people to do tasks or processes that WE know how to do, have told or shown them at least once (or more) how to do it, and they ought to know. Telling is not teaching. The time dedicated to build competence in a new accountability is nearly always underestimated, and especially so for those low frequency tasks. Teach back. See one, do one, teach one. Like purpose, mastery of skills is an intrinsic motivator so create an environment of success in learning.
    • WHEN? What are interim due dates and exactly what is due when? No one has all the details that you have so be clearer than you might think you need to be. Where you can, allow choice about the when, e.g., “This can be completed now or in the month before your performance review. When would you like to set your own deadline within that parameter?” And a fun fact: asking people to set a time and place to do a task dramatically increases their likelihood of completing it. Allowing some choice in the time frame is one way to foster autonomy-the third key component of intrinsic motivation-even if the final deadline is not up for discussion.  
    • WHO? As with most aspects of leadership, accountability is higher when relationships are strong. Highlight how the work to be done impacts others on the team and patients. Two kinds of power in leadership are position power and relationship power. You can fire people from your position power, but you can get their best work if they know you care about them as a person.


“Chasing people down” is a strategy but take the long view on this one. Once you find them, teach them a new way to treat you and the tasks you are asking of them. Build the kind of relationship where they won’t want to let you down. Answer the questions above. Facilitate their problem-solving skills. Next time, you might not have to chase them down.


Jo Anne Preston In Jo Anne's current role as Organizational and Workforce Development Senior Manager at the Rural Wisconsin Health Cooperative (RWHC) her aim is to offer to leaders straightforward tools and inspire the courage to use them.
Leading The Way In Five Mintues A Day

Lead the Way in Five Minutes A Day: Sparking High Performance in Yourself and Your Team, by Jo Anne Preston is currently available for purchase.

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