stoke strategy ppt

8/12/2019 Stoke Strategy PPT

1/20

Accountability in Health CareDr. Judith Shamian

April 19, 2010


2/20

Accountability in Health Care Page 2 www.von.ca

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)


3/20


Levels of Complexity

Simple

Complicated

Complex

Level of Complexity


4/20


COMPONENTS

OF

ACCOUNTABILITY


5/20


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)


6/20


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



7/20


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


Accountability in health care consists of at least six

domains.


8/20


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



9/20


MODELS OF

ACCOUNTABILITY


10/20


The Professional Model

The Economic Model

The Political Model

The Organizational Model

The Governance Model

Models of Accountability


11/20


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



12/20


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



13/20


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



14/20


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


15/20


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)


16/20


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


17/20


18/20


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


19/20


- 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


20/20


and the journey continues.

Health Starts at Home www.von.ca

The Journey Continues

stoke strategy ppt

Documents