Understanding and Implementing Best Practices in Accountability

There has been much emphasis on accountability in health care in all jurisdictions across Canada. Using document analysis and key informant interviews, we assessed the extent to which the findings from our earlier Ontario-based study, Approaches to Accountability, applied across Canada. Accountability done well improves performance, improves the patient experience and promotes efficient use of resources. If implemented poorly, it can waste valuable resources, create perverse incentives and encourage gaming in the system. The findings of this study reinforced the earlier findings. Our respondents stressed that it was important to focus on the goals being sought and transition points in the system; they emphasized that resources and stable leadership were key. Although good metrics are essential, they are not always available. Accordingly, what is easily measured tends to be what is reported. Organizations are also reluctant to be held accountable for what they cannot control. They noted that too many organizations are asking for too many indicators in too many forms. Although this is particularly problematic for small organizations, it is not exclusive to them. Moving forward, it will be important to streamline and prioritize reporting metrics, ensure adequate resources are available to support accountability and educate users as to the value of reporting accountability activities, by showing them that there is something in it for them. In addition, it is important to encourage coordination and sharing among the multiple bodies that request similar information in different forms. Finally, it is important to ensure that that which is difficult to measure is not lost in the shuffle