Debates on the issue of accountability have emerged as a way of controlling costs; improve safety and quality of care and promoting the health of the population. Behind the accountability notion, lays the idea that to some extent healthcare delivery systems have unexploited gaps for improvement if utilization of resources is aligned with appropriate and effective care (Denis, 2014). Although accountability aims at streamlining operations in the healthcare sector, the concept is often misunderstood due to the ambiguity in its definition. However, accountability is commonly understood from the catch-all point of view where governing bodies such as healthcare board, government, professional association and regional health authorities have been bestowed with powers to mandate healthcare organizations and providers to achieve certain objectives or goals. With the legitimacy, supremacy and authority of these governing bodies, healthcare providers are obliged to account for their achievements as per the stipulated objectives and goals. Accountability therefore plays a vital role in alleviating the challenges faced in healthcare. On this view, the paper aims at analyzing individual role in ensuring accountability; defining Accountability Care Organization; exploring challenges faced in pursuit of accountability in healthcare and the impact of these challenges on changing the role of the healthcare worker.
To begin with, accountability considers individual efforts by healthcare providers to take responsibility of their action. Therefore, the first step towards taking part in accountability entails understanding the elements of this concept . Aveling, Parker & Dixon ‐ Woods (2016) indicate that accountability is based on three major elements namely; the object of accountability which constitutes a clear definition of desired objectives and goals, the ability to measure, evaluate and assess goal achievement and establishment of consequences related to unsatisfactory outcomes. As an individual, specifically a healthcare provider, playing part in accountability necessitates one to understand the elements and approaches to accountability. For instance, individual efforts by a healthcare provider are demonstrated through response to existing quality aspects in the health care settings such as patient safety (Aveling, Parker & Dixon ‐ Woods, 2016) . In this case, a healthcare provider is mandated to follow safety measures when handling patients. However, the provider might unknowingly compromise patient’s safety leading to undesired outcomes. Since human is to error, an individual accountability will be manifested by the moral agency to take responsibility and report the incidence and face consequences if any. Besides, it’s possible to defend one’s actions and object suggested punishment on the basis of professional code of conduct and ethical principles that might explicate reasons for the actions and provide normative grounds for its justification.
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As mentioned earlier, the high healthcare costs have contributed to the wide array of debates on the efficacy of accountability in alleviating such expenses. In combating potential financial loopholes, policy formulators have shifted the focus of individual based reimbursement methods such as fee-for service, a method characterized by payments using of out-of-pocket to value-based approaches ( Colla & Fisher, 2017). The need for financial accountability contributed to the creation and adoption of Accountability Care Organization. Notably, Centers for Medicare and Medicaid Services (CMS) defines an Accountability Care Organization (ACO) as a structure linking groups of providers among them doctors and other healthcare providers and hospitals with an aim of providing high quality care and coordinated care to patients insured by Medicare ( Colla & Fisher, 2017). The passage of the Affordable care Act formed the baseline for the creation of Accountable Care Organizations.
As a centerpiece of the Affordable Care Act, a novel feature of Accountability Care Organizations is shared responsibility. The latter attributes to the diverse array of providers with mixed capabilities; differing governance and legal structures and varied contracts that create service dimensions. Besides, integration of care management programs, adoption of advanced analytical systems which aids in estimating hospitalization risks and shared decision making defines the underlying structural building blocks ( Colla & Fisher, 2017). A strong bipartisan support to Accountability Care Organizations over the years aligns with the goals of increasing efficiency, developing care coordination, patient satisfaction and regulating expenditure in health care delivery.
Although healthcare is a fundamental human right, challenges faced in this sector affect the outcomes and quality of healthcare delivery. Salmond & Echevarria (2017) indicate that suboptimal outcomes, fragmentation, unsustainable costs, disparities and accessibility problems in healthcare evoke the need for change. Accountability in healthcare is a fundamental approach that has been applied to address matters of urgency including quality and cost. However, with accountability emerges the conceptualization challenge. For instance, ambiguity in defining accountability brings forth insights to how the concept is understood by varying cadres in the healthcare sector (Duthie, 2018). Arguably, accountability is mirrored as catch-all government policy that mandates providers to abide by stipulated objectives. Alternatively, accountability is viewed as a concept that supports good practice and implies the urgency to face consequences of actions. Difficulties in articulating the definition of accountability, contributes to the blame culture in healthcare that stem from the discrepancies in determining the parties that ought to claim responsibility. Duthie (2018) states that the question whether the system or the individual should account for patient safety seemingly fuels the accountability debate. Ultimately, flaws in attributing individual accountability to the system and holding individual accountable to their actions collaboratively exposes the challenges faced in the practical application of accountability in organizations.
With growing concerns on healthcare challenges such as quality and cost, there is need for transforming and changing the roles of healthcare providers. Importantly, reducing healthcare costs drives necessitates a change of healthcare providers’ role towards reducing spending that is attributed to repeated medical histories, repeated diagnostic testing, unnecessary emergency department utilization and unnecessary hospitalization inherent with the nurses duty as caregivers, the adoption of value-based models forces a change from provider-centric roles to patient-centered approach in which the provider respects autonomy and engages the patient in promoting behavioral change capacity and self-determination (Salmond & Echevarria, 2017). However, improving the outcomes and quality of care requires greater coordination of care that shifts focus of healthcare providers’ role to inter-professional engagement in shared decision making across healthcare settings.
In conclusion, accountability in healthcare is of great significance. Adoption of new models such as the value-based financing are changing the paradigm of care from the paternalistic disease-based model of managing episodic illnesses , without adhering to quality measures, to a focus on healthcare systems emphasizes on quality outcomes, rewards deserving providers and ensures population health by supporting prevention of diseases and disease progression. However, understanding accountability drawbacks in healthcare is equally important and promotes individual responsibility. To sum up, achieving timely, cost-effective, efficient, equitable, safe and patient-centered outcomes greatly relies on accountability in healthcare.
References
Aveling, E. L., Parker, M., & Dixon ‐ Woods, M. (2016). What is the role of individual accountability in patient safety? A multi ‐ site ethnographic study. Sociology of health & illness , 38 (2), 216-232.
Colla, C. H., & Fisher, E. S. (2017). Moving forward with accountable care organizations: some answers, more questions. JAMA internal medicine , 177 (4), 527-528.
Denis, J. L. (2014). Accountability in healthcare organizations and systems. Healthcare Policy , 10 (SP), 8.
Duthie, E. A. (2018). Accountability: challenges to getting it right. Journal of patient safety , 14 (1), 3-8.
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing , 36 (1), 12.
