The Social Construction of Accountability: Radiologists and Their Record-Keeping Practices

Abstract Record-keeping practices are a central means by which organizations demonstrate accountability. These practices, though, are socially constructed and owe as much to organizational or professional cultural and ethical norms as to laws or procedural manuals. This article discusses accountability as a social construction situated in a specific spatial, temporal, and social setting; specifically, it details a qualitative study of radiological reading rooms. This research focuses on the preparation of one form of documentary evidence, the radiological report. Major findings include the need to think about accountability in the plural. Multiple accountabilities exist in both record-keeping processes and the records themselves. Sustaining and balancing these accountabilities can be difficult and can lead to compromises. Furthermore, accountabilities are the result of an iterative process between the individual and organizational levels that is required to make accountability robust and make it work.