Johns Hopkins’ physician Marty Makary is campaigning to make healthcare safer – and cheaper – by publishing healthcare outcomes for all to see. His new book, Unaccountable, is sure to be a clarion call for true healthcare reform – as opposed to the partisan bickering we hear on a daily basis. We should all be grateful for him and his tremendous work in this area.

The Accountability Dance

The call for reform is simple and clear. Transparency and accountability are critical for true and positive change, yet people rarely embrace accountability – especially people in positions of power. Accountability “occurs” under two conditions: either it is imposed forcibly by another, or one willingly offers (submits) to it.

It takes a lot for people, and organizations, to reach the point where they are willing to impose accountability on someone they know. The concern for harmony, draw of money, focus on short term goals, and an inner fear of hypocrisy are all overwhelming forces that drive people away from it. It takes courage.

Under what conditions will a person voluntarily submit to accountability? People submit to accountability when:

• the authority has the person’s personal interests at heart
• the authority is just and fair in administering consequences
• they share a common and compelling goal or value
• there is an opportunity to learn from or redeem the situation

Absent these conditions, people squirm out of personal ownership for their gaffes, and they deflect responsibility for their behavior.  Absent these conditions in healthcare we will find doctors and hospitals fudging their numbers – thus thwarting the goal of better care.

Solutions?

I wonder just how we can create a system that conforms to these conditions. And if we do, there is still much more work to be done. In healthcare, we need the kind of management innovation Gary Hamel discusses in The Future of Management. It’s a tall order, and it will take the combined efforts of many, many people. But I am ready and eager for the challenge. How about you?