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February 16, 2023
You don’t have to hold someone’s feet to the fire when they are willing to walk across hot coals on their own
Twenty years ago the dominant management buzzword was Empowerment. You don’t hear that word very much anymore. Today the buzzword du jour is Accountability.

It’s almost as if management gurus, and those who follow them, are saying, “We tried the empowerment thing and it didn’t work, so now we’re going to crack the whip and hold people’s feet to the fire” – the two most common metaphors for holding people accountable, torture techniques that have been outlawed since the Middle Ages.

Is it any wonder that people take a step back when you say, “You will be held accountable.”

In today’s world we need a new buzzword. We need to replace Accountability with Ownership.
Accountability is doing what you are told to do because there are consequences. Accountability is imposed by the extrinsic motivation of reward and (mostly) punishment.

Ownership is doing what needs to be done because you expect it of yourself. Ownership springs from the intrinsic motivation of personal pride. In a Culture of Ownership everyone has the same job description: first and foremost a caregiver, last but not least a janitor, and in between whatever else needs to be done.
There are six serious downsides to an excessive cultural focus on accountability:

Downside #1: Accountability is always perceived as being punitive and as a threat. You never hold someone accountable for having done something great or for having gone above the call of duty, only for having failed to do so. No one ever goes home at the end of a workday and brags to the kids that “the boss held me accountable today.” They’re more likely to go to the breakroom and complain about how unfair it was.

Downside #2: Accountability always points a finger at someone else. In more than 25 years of consulting with healthcare organizations, I have never heard anyone say, “The problem with this place is that no one ever holds me accountable.” The finger is always pointed at someone else. When General Motors was being investigated for safety violations, the final report described the GM Salute – arms crossed over the chest with fingers pointing outward.

Downside #3: Accountability can undermine the principles of just culture. Under just culture, when problems or errors happen, we are to look first at systems and processes, technology and culture, and not immediately seek to find fault in individuals. But since you cannot hold systems and processes or technology and culture accountable, the search for accountability inevitably ends up blaming a person. The more often individuals are held accountable, the less likely they will be to identify problems and errors, especially their own.

Downside #4: Accountability establishes a low bar of performance expectations. People can only be held accountable for having performed what they’ve been told to do, what was in their job descriptions. You cannot hold someone accountable for not having done something that they were not told to do. More than two million nurses have been nominated for DAISY Awards. In virtually every single case, the nomination was for having done something above and beyond what might have been learned in nursing school or included in a job description. No one was ever honored with a DAISY Award because they were being held accountable.

Downside #5: Accountability can establish perverse incentives. As Richard Farson and Ralph Keyes wrote in their book The Innovation Paradox, “In the long run… accountability encourages a culture of evasion, denial, and finger pointing.” The ethics scandal that so badly tarnished the Wells Fargo company was largely caused by salespeople who cheated customers because they feared being held accountable for what they believed were impossible sales quotas.

Downside #6: A focus on accountability can drive good people out of the profession at a time when they are most needed. The day RaDonda Vaught was sentenced for having made a fatal medication error I happened to be speaking with the chief nursing executive of a large health system that owns a nursing school. Within hours of the verdict being announced, she told me, three newly accepted students had withdrawn with words to the effect that they were not willing to assume the risk of going to jail (the ultimate in being held accountable) for making an error. The more we use that word accountability, the more we are likely to exacerbate the pervasive anxiety and sense of dread that are already at epidemic levels.

If you think that the way to increase performance in your organization is to do a better job of holding people accountable, it’s a pretty safe bet that while you might achieve some short-term gains, over time the longer-term harm of unintended consequences will outweigh them.
For more check out these books on moving from accountability to ownership:

Building a Culture of Ownership in Healthcare, Second Edition
The Florence Prescription: From Accountability to Ownership
All Hands on Deck: 8 Essential Lessons for Building a Culture of Ownership

Next week: The 3 Levels of Accountability