Juran Healthcare

	Health Care Case Studies


	Consulting


	Public Workshops


	On-Site Training


	Training Materials


	Quality & Process Improvement

Quick Strike Assessment

Design for Lean Six Sigma (DMADV)

Lean Transformation and Six Sigma (DMAIC)


	Patient Safety

Culture & Adverse Event Assessment

Accountability Systems

Human Performance Improvement

PDSA


	Strategic Planning & Deployment Services


	Change Management


	Juran Store


	Home >	Health Care > Patient Safety > Accountability Systems

Accountability Systems

Based on Juran's Trilogy and leading human resources research into employee behavior, Juran Healthcare offers experience and expertise in implementing fair and just accountability systems. Our approach ensures that the manager or leader invests the appropriate amount of their work week engaged in quality planning, improvement, and control, while also ensuring that they use a consistent and fair approach to holding health care workers accountable for their errors. Our work includes the following accountability applications:

1	*Chain of Command Procedures for Physician Rule Violations* should be clear, concise, and communicated to all levels of the organization. When patient safety practices are compromised by any member of the staff, a feedback loop must be in place in order to return the system to a safe environment for patients. The variance reporting system should provide an anonymous way of reporting non-compliance, in addition to prompt accountability to ensure the empowerment of front-line staff. Once the chain of command is in place and enforced over time, the culture of the organization will mature to enable a more focused approach to system issues rather than individual compliance issues. If physicians and staff are not held accountable to upholding quality and patient safety practices, then improvement projects will fail to provide any effective or sustainable results needed to reduce serious safety events and human error.
2	*Accountability System to Reduce Non-Compliance* should be developed and utilized as part of the overall performance management system. In health care, very few human resource performance management systems provide a healthy mechanism for dealing with human error, especially those involved in serious safety events. Accountability systems should be fair, just, consistent, and equally applicable to all levels and professional groups of the organization. A non-punitive culture must be established to ensure healthy incident reporting so that corrective action and improvement activities can occur.
3	*Team Leader Rounding* is vital to the sustainability of all patient safety initiatives. The mantra behind this concept is "you get what you inspect, not what you expect." Rounding should always be purposeful and structured around the patient safety and behavior-based expectations defined for the organization. The purpose of rounding is to display management commitment to patient safety, uncover error precursors and chronic problems, obtain feedback from staff, and satisfy the 5:1 ratio of positive to negative feedback to staff. The 5:1 ratio of positive to negative feedback is a core competency for team leaders to ensure accountability to patient safety processes and behaviors.
4	*Peer Coaching Programs* (Safety Coaches) are the cornerstone for patient safety culture transformation that occurs at the grassroots level by providing real-time coaching for continuous improvement. Safety coach programs provide real-time behavior-based monitoring, feedback, and data collection. Real-time behavior-based monitoring reduces both error precursors and serious safety events by transforming knowledge-based error prevention practices into skill-based patterns of behavior. The programs also provide data that can be used to track behavioral trends and human performance improvement.