Accountability in Healthcare Organizations and Systems

A ll debates about the way to improve the quality and safety of care, the control of costs or the health of the population, raise the issue of accountability. Behind this notion, there is the idea that healthcare systems have an unexploited margin for improvement if they better align the utilization of resources with what is known about the appropriateness and effectiveness of care (Maynard 2013). The common understanding of accountability is one in which a governing body (e.g., government, regional health authority, healthcare board, professional association) is in a position to mandate providers or organizations to meet certain goals or objectives. Because of the authority or legitimacy of these governing bodies, providers or organizations believe they must account for their achievements in relation to such goals or objectives. The relationship between these two sides of the accountability equation is not necessarily hierarchical -at least in principle An accountability relationship can be based on a dialogue where providers or organizations argue with governing bodies about their relative achievement of predefined goals. Even the definition of goals and objectives can be made through a collaborative process between governing bodies and concerned providers or organizations. That is, in brief, the notion of accountability does not have to be reduced to the application of formal controls on one' s own activities or behaviours.