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Exploring Person-Centered Accountability as a Complementary Approach to Regulatory-Centered Accountability: An Action Research Study

Debbie G. Stock

Ph.D. Dissertation, Northcentral University, September 2015

For a PDF version of the complete paper, click here.

Abstract

Accountability in healthcare tends to dominate discussions focused on improving the quality of care, the experience of patients, pay-for-performance, and engaging employees to produce positive performance outcomes. Organizational leaders are held to answer to external regulatory agencies about performance outcomes based on prescribed standards. Frequently, these agencies adopt a punitive approach by imposing rewards and penalties for achieving or failing to meet the performance standards. Furthering the challenges, organizational leaders are expected to model accountability, hold employees accountable, and be a source for inspiration and motivation. The purpose of this qualitative action research study was to examine person-centered accountability (PCA), or the use of positive leadership, positive practices, and positive emotions, as a complementary approach to regulatory-centered accountability (RCA). Six workshops influenced by appreciative inquiry, a practice period, participant journals, interviews and the use of a portable biofeedback device to measure positive emotions were all utilized to develop an understanding of participant’s experiences and perceptions about the value of PCA and RCA. Participants were clinical and non-clinical leaders at a Midwest medical center. Results from this study revealed the participants’ perception about the holistic and interdependent nature of PCA and RCA. Integrating PCA and RCA requires a change in philosophies as well as day-to-day accountability practices. Leaders and employees need to use both PCA and RCA to improve performance outcomes, therefore, it is important to create an organizational reset to change beliefs about accountability, build leadership capacity, and invest in employees. Future research is needed to evaluate the long-term impact of PCA and RCA on performance outcomes in and out of healthcare.