stoke strategy ppt
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Accountability in Health CareDr. Judith Shamian
April 19, 2010
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At its most basic, accountability is about individuals who are responsible fora set of activities and for explaining or answering for their actions.
It is being answerable for something.
It should be positive and premeditated.
It emphasizes keeping agreements and performing tasks in a respectfulmanner.
It is about learning, truth and continuous improvement.
Accountability ranges from micro to macro from personal to
organizational to system to international.
Without accountability, organizations are incapable of achieving andsustaining high performance.
What is accountability?
(Emanuel & Emanuel, 1995; Paul 1997)
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Levels of Complexity
Simple
Complicated
Complex
Level of Complexity
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COMPONENTS
OF
ACCOUNTABILITY
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The concept of accountability contains
three essential components:
1) the loci of accountabilityWHO
2) the domains of accountabilityWHAT
3) the procedures of accountabilityHOW
Component of Accountability
(Emanuel & Emanuel, 1995)
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The loci of accountability
is simply the parties that
can be held accountable
or hold othersaccountable.
Health care consists of
at least 11 loci of
accountability.
Loci of Accountability - WHO
(Emanuel & Emanuel, 1995)
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A domain of
accountability is an
activity, practice, or
issue for which a party
can legitimately be
held responsible and
called on to justify or
change its action.
Domains of Accountability -
WHAT
(Emanuel & Emanuel, 1995)
Accountability in health care consists of at least six
domains.
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There are two components to the procedures of
accountability.
Evaluation of the adherence to or compliance with
the criteria for specific content areas.
Dissemination of the evaluation and responses or
justifications by the accountable party or parties.
The Procedures of
Accountability - HOW
(Emanuel & Emanuel, 1995)
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MODELS OF
ACCOUNTABILITY
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The Professional Model
The Economic Model
The Political Model
The Organizational Model
The Governance Model
Models of Accountability
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The physicians and patient participate in shared decisionmaking and physicians are held accountable to professionalcolleagues and to patients.
In medicine, the traditional model of accountability has
been the professional model. In this model, health care is not a commodity but a
professional service.
Two primary loci of accountability: Physicians to their professional colleagues and organizations
Individual patients
Two primary domains of accountability: Competence
Legal and Ethical Conduct
The Professional Model
(Emanuel & Emanuel, 1995)
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Market is brought to bear in health care and accountability is
mediated through consumer choice of providers.
Patients are viewed as consumers; physicians and hospitals, as
providers or economic producers; and health care, as a commodity
or product.
Locus of accountability is the relationship between individual
consumers and providers of health carephysicians, hospitals, and
managed care plans.
Traditionally, government is seen as marketplace regulator ensuringefficient, competitive, and fair operation of the market.
The primary domains are price and qualityfinancial performance
and professional competence.
The Economic Model
(Emanuel & Emanuel, 1995)
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Physicians and patients interact as citizen-members within acommunity and in which physicians are accountable to agoverning board elected from the members of the community.
Patient well-being is neither a commodity nor a professional
service. The goal of health care remains the patient's well-being, but its precise content and the optimal mechanism forachieving it are subject to interpretation by the community ofcitizen-members.
Locus of accountability is the relation of providers to agoverning board of representatives. In turn, this board is
accountable to the members, both patients and physicians.
The primary domains of accountability are not fixed.
The Political Model
(Emanuel & Emanuel, 1995)
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Organizational accountability exists when all members of the workforceindividually and collectively act to consequentially promote the timelyaccomplishment of the organizations mission.
All members of the workforce:Executives and managers areresponsible for holding their subordinates accountable for the effectiveand efficient conduct of activities supporting mission achievement.Subordinates, through their actions, set an example by which positive
pressure is applied to their peers and seniors for greater accountability. Individually act:Enough individuals throughout the organization must
act accountably in order to achieve the critical mass necessary for theexistence of an accountable organization.
Collectively act:Often, groups of executives, managers, or individualcontributors make and execute the organizations decisions.
Consequentially promote:Accountability cannot exist without bothpositive and negative consequences.
Timely accomplishment of the organizations mission:Foraccountability to exist, one must know what is to be accomplished andwithin what time frame.
The Organizational Model
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There are several different kinds of Governance Models including:
Advisory Board Model - This model emphasizes the helping and supportive role of theBoard and frequently occurs where the CEO is the founder of the organization.
Patron Model - Similar to the Advisory Board model, the board of directors in the PatronModel has even less influence over the organization than an advisory board.
Co-operative Model - In this model, all responsibility is shared and there is no ChiefExecutive Officer. Decision-making is normally by consensus and no individual has powerover another.
Management Team Model - Boards operate by organizing their committees and activitiesalong functional lines. In larger organizations, the structure of the board and its committeesusually mirrors the structure of the organization's administration. Just as there are staffresponsible for human resources, fund-raising, finance, planning, and programs, the boardcreates committees with responsibility for these areas.
Policy Board Model - The job of the board is: to establish the guiding principles and policiesfor the organization; to delegate responsibility and authority to those who are responsible forenacting the principles and policies; to monitor compliance with those guiding principles andpolicies; to ensure that staff, and board alike are held accountable for their performance.
The Governance Model
(Nathan Garber & Associates)
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Built on 5 key functions of governance: Developing the mission,vision and values; collecting and using knowledge andinformation; developing the organization; building relationshipswith stakeholders and demonstrating accountability.
These standards are grouped into six subsections based on
the five functions:
1. Developing a clear direction
2. Building knowledge through information
3. Functioning as an effective governing body
4. Supporting the organization to achieve its mandate5. Maintaining positive relationships with stakeholders
6. Being accountable and achieving sustainable results
System Model:
QMentum ProgramGovernanceStandards
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All components within the system must work together towardsto end result of improving patient outcomes.
If one component of the system is not functioning properly,others will suffer.
The goal is positive and productive patient and practice teaminteraction.
Healthy public policy, supportive environments and communityaction, along with delivery system design, clinical information
systems, decision support and self managed support must allwork in harmony
If these components are all accountable to one another thenimproved patients outcomes should be achieved.
Systems Accountability
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- The Canadian Stroke Strategy needs to be treated as a
complicated system
- In addition to the Best Practice Recommendations thereis a need for a role, responsibilities, accountabilities tool
kit
- There is also a need for an evaluation/accreditation tools
and processes that can evaluate/monitor and provide
feedback on the Strategy implementation and
maintainance
Challenges-Next Steps
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and the journey continues.
Health Starts at Home www.von.ca
The Journey Continues
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