Monday, December 21, 2009

On accountability

A "benefit" of being a CEO is that publishers send you copies of all the new management books, presumably so you will recommend them to your colleagues. Most are not very good. If you are lucky, a book will have one good idea that is stated in the introduction or first chapter. Then they fill the book with poorly edited repeats of the same concept. Often, they use a large font so the book will have more bulk.

This week's book is by Quint Studer and is called Straight A Leadership: Alignment, Action, and Accountability. (Fire Starter Publishing, Gulf Breeze, FL) I skipped the first two topics but found the chapter on the third. I have been thinking a lot about accountability and was curious to see what he said. The crux of his case was, "What we find is that most organizations fully grasp the importance of accountability, and they put guidelines into place to hold people accountable to -- but somehow, they fall short of closing the loop."

Over the past few months, I have come to a conclusion about accountability that is at variance with most management guidance on the subject. That guidance suggests, as in Studer's book, that a successful organization depends on holding people accountable to do good quality work in support of corporate objectives. I'll assert instead that it is not only impossible to hold people accountable in an organization, but trying to do so is a misallocation of managerial attention.

You say, "What? How will you make sure people are performing up to spec if you don't hold them accountable?"

I view the job quite differently. I view the leader's job as helping to create an environment in which people are so comfortable with their role in the organization, and are given the right tools for doing their job, that they hold themselves accountable. After all, most people want to do well in their job and want to do good in fulfilling the values of the enterprise. Why not trust in their inherent desire to be successful personally and collectively? Instead of focusing on measuring their performance against static metrics, why not create a setting in which they use their native intelligence, creativity, and enthusiasm to solve problems in an inevitably changing environment? Then, spend your time praising them and making sure they get credit. (See John Toussaint's and Paul O'Neill's thoughts here for variations on this theme.)

People who have heard my speeches know that I often make analogies between running a hospital and coaching a girls soccer team. (Regular readers know this all too well!) Your purpose as coach is not to criticize by pointing out errors and areas of deficiency. The players (workers) already know when they have made a mistake or are not performing up to par. Your task, instead, is to give them the chance to learn tools that enable them to meet a high standard, both individually and as a team.

I'll stop here for now on this topic and take your comments on my premise and on how it feels to work in your organization. Do you know what your role is, individually and with respect to the institution's objective and values? Are you respected and treated with dignity, regardless of your position in the organization? Are you given the tools you need to do the job? Are you recognized for what you have done?

I'll be the first to admit that our hospital leadership team still falls short in many respects. We are trying hard, but we are neophytes in this new mode of management. We need to learn to listen better so that we can be better coaches. Our goal, though, is to make it possible for each person to answer these four questions with a resounding "Yes." If we can do that, there will be no need to hold people accountable.


Anonymous said...

Sounds like basic Deming and Juran. Most people want to do a good job. The difficulty is creating an environment where they are able to do a good job. Those who don't know what a good job is need education much more often than they need supervision.

Leigh Hamby said...

Paul, I too subscribe to your philosophy. I have found much solace in the "complexity" literature of Ralph Stacey and others to help explain our shared "counter culture" feelings about this topic.

Anonymous said...

I do agree with your philosophy, but maybe it can work with the approaches described by Studer. One can work well in the environment you describe knowing that there are still some 'sharp edges' within the management system that will address the inevitable accountability issues.
Also, thank you for continuing to share your insights on this terrific blog.

Anonymous said...

Umm, lots of people will always be in jobs where they don't particularly care about the goals of the organization and may even find them objectionable.

In an ideal world, we would all believe in our work, but in plenty of places that's not possible.

Anonymous said...

I think it covers a lot more places than you would think, but certainly health care institutions.

Anonymous said...

Although I agree with your over all philosophy and one of the reasons I read this blog is to learn from your demonstrable leadership skills; health care certainly contains its share of unengaged people. From the nurse who ignores the lab tech, to the clerk who eats her snacks at the patient desk in the oncology clinic (this I saw at Johns Hopkins), they exist. And one of the most demoralizing effects on co workers is to see these people get away with it.
So I regard this issue similarly to the "blame" vs. "no-blame" approach to medical errors - it's difficult to know where to draw the line.


Anonymous said...

Perhaps I have never worked in an organization so utopian that everyone was intrinsically motivated to to their job to the best of their ability. But I've worked in travel, education, advertising, consulting, and healthcare. I've worked in union and non-union environments. But I've recently been managing entry-level (though some have been in this role for 20+ years) registration staff in a hospital setting, and oh boy - do they require major oversight. I've tried everything - talking about long term career goals, career paths, pay raises, overtime, good reviews, etc, etc, etc. But as soon as we turn away, they're shopping online, chewing gum, missing patients, etc.

I agree that I don't need a system of accountability to get myself moving and doing my work to the best of my ability. But I disagree that creating some kind of supremely-nirvana like work environment will somehow inspire greatness.

I'll leave you with a quote from office space:
"It's a problem of motivation, all right? Now if I work my ass off and Initech ships a few extra units, I don't see another dime, so where's the motivation? ... my only real motivation is not to be hassled, that and the fear of losing my job. But you know, Bob, that will only make someone work just hard enough not to get fired."

Anonymous said...

Dear nonlocal and Anon 12;23,

Blaming the workers for an environment that is not conducive to a productive and positive is an unfortunately typical response of management.

Before we think about a "supremely-nirvana" environment, let's start with one that is simply respectful and helpful and engages people in designing their own work flow.

Anonymous said...

I have a manager that reads your blog quite often and they are the bes I have ever had the opportunity to work with. I work at BIDMC in an environ that fosters quality and creativity, the value product is accountablity because I value and respect the role, the goal and the expectation - I own it, I am accountable. I am not supervised or directed but rather encouraged, supported and provided the tools, solutions and support needed to do the best job possible. I a staff worker responsible to patients' and peers' to do the best I can in my role. Yes I spend the occassional moment online reading your blog and others but that does not make me unaccountable or the producer of subquality work, rather it produces value added for my role. Bravo for allowing and encouraging this philosphy, it can work and does.

Anonymous said...


Taking a page from your book, I contest your assumption that I'm "blaming the workers". I simply offered two specific real life observations of behavior that is not appropriate. One could say you were "blaming their manager" for failing to provide an environment
in which they would not think a lab worker is beneath them, or have so little regard for cancer patients that they eat in front of them. I agree that education otherwise would work for some people, but for others I would question whether this is a personality trait that renders them more useful in a non-people-contact environment. (In other words, if you find yourself having to train people in basic respect for other people, then you already have a problem.)


Anonymous said...

In world class organizations, leadership is in charge of assuring that these four foundational aspects are implemented:

No blame
Systems thinking
Problems are opportunites
Focus on process

Most people go to work and are not sure if they are having a good or bad day. What is worse, is that much of our time is wasted on non value added work. With a focus on the above foundational rules by all (including leadership), we will all be much better off and our daily work will be more enjoyable

catsandmusic said...

Anon12:23, I have had similar experiences to yours. People are willing to let the hard worker do the lion's share, and it is up to management to notice this. If there were a way to index productivity in the front desk positions, where I worked for a part of my career, it should be done. I stood in a line in a specialty service at BIDMC a few months ago and watched only one person of three check in people. One of the other clerks was on what was clearly a personal call, and the other was engaged in a conversation with a coworker from the back of the office that also was audibly not work-related. I picked up on the dynamic right away, as that used to be my life.

Paul: I laud your idealism, and I share it, which is why I kept working as hard as I could in whatever job I had, not looking to others' productivity or lack of it as my yardstick. But you need to realize that just as there are low level employees who do the minimum or less, there is management at your insttution that is best described in Palinesque terms (I thought of Machiavellian, but that gives them too much credit) as rogue. Please look at the employee Press-Ganey survey from last year. Ask HR which departments had employees call for reassurance that the survey was indeed anonymous. Look at where the lawsuits are. Look at where the job postings are. It is not merely front desk clerks who revert to bad behavior when they know the supervisor is not watching.

Anonymous said...

Dear nonlocal,

I'm so pleased we finally get a chance to really disagree! Please see Anon's 2:33 comment.

I would argue that people who have "a personality trait that renders them more useful in a non-people-contact environment" are in a very small minority. People who are put in bad work situations often behave poorly, even people who have good manners, good upbringing, and good intentions.

Anonymous said...

As you know, we come from very different cultures, mine being the traditional physician's culture of individual responsibility. I understand exactly what you and 2:33 are saying, and I of all people realize that a bad environment in health care can lead to this behavior. (I firmly believe it is also responsible for most 'disruptive physician' behavior - have you included that in your equation?!). But in my clinical practice, my experience more resembled anon 12:23's. Granted, patient registration areas can be a zoo, but so can grocery stores - and I rarely encounter a truly rude grocery clerk.......


Anonymous said...

Transferred from Facebook:

Rick; You CEO's must secretly chat wiith each other about these things. I just had a discussion with ours about specifically about holding people accountable versus simply creating an environment amenable to success. My amateur observation is that people like to know that they have been paid attention to. Last year all our managers had access to their individual patient satisfaction survey scores. This year we started posting the scores, all of them, on an interactive dashboard. Now everyone could see everyone else's scores. This year our scores rose 10-20 percentile points. No one was pointed out as being "bad", but the fact that they knew that others (including our line employees) could see their results allowed our managers to be accountable to each other and their staff.

The discussion here is whether it is more effective to maintain a positive atmosphere utilizing trust or to be transparent and “accountable” to each other.

Could we get the same results without making everyone's scores available across the organization? Would managers feel we respect them more by taking down the dashboard and expecting them to do just as well without the peer pressure? I am reluctant to find out. I think that people like to know that if they are not performing well it will be noticed because they know that if they turn things around and start to excel it will be equally noticed and celebrated.

Benjamin: I think the goal of good coaching is not just to provide people with the tools but also to get them thinking again. Obviously coaching one-one-one (say, as a soccer coach) is different than coaching a large organization. However, maybe it's also possible to get people thinking again as the coaching C.E.O. of a large organization - I've never seen ... more in anywhere else at the B.I.
The common thread seems to be that both providing workers/players with new tools and get them thinking again might boost morale and one's sense of responsibility (or accountability).

I would like to add that a good coaching session can be closed -if appropriate- by letting the coaches decide on measures of success or, if you will, define how you hold them accountable. That would obviously be a difference between one-on-one coaching and coaching a large organization.

Ralf: A really excellent post just before the turn of the year. Time for all of us to rethink our daily actions.

Quote from your initial post: "I view the job quite differently. I view the leader's job as helping to create an environment in which people are so comfortable with their role in the organization, and are given the right tools for doing their job, that they hold themselves accountable."

A CEO is nearly the same a coach on the field (only with mostly a much larger working force). Coaches mentor players, open the paths to the player to play to his strengths, seeing the whole picture.

The coach is at his best, when the players can say, "We have achieved the goal together!"

Anonymous said...


You presented a false either-or: "The discussion here is whether it is more effective to maintain a positive atmosphere utilizing trust or to be transparent and 'accountable' to each other." It is both.

dls said...


I've made a similar, but different, point in my own blog. I think what you've added is a nice complement.

Some time ago, I argued that the Studer emphasis on hiring the right people (and firing the wrong ones) is not particularly useful and probably wrong. The posts are here and here.

I think your post puts to rest another piece of (false?) conventional wisdom about management.


Illysa said...

Hello Paul,

A student sent me a link to this blog and he's absolutely right in thinking I would appreciate it.

Students are not told to send links to leadership information, yet they do so all the time. Grades are in, so he's not "kissing up." He is self-motivated.

The vast majority of people I meet are happiest when they are self-motivated. But yes, there are those who do not do anything without a proverbial stick. I believe they do not know they'd be happier by being self-directed. I disagree with the person who believes that teaching people basic respect evidences you already have a problem. Not everyone learned how to treat themselves or others with basic respect.

What a gift we give the people who report to us when we teach them how to lead themselves.

And perhaps it is unrealistic to believe that 100% of people will become self-motivated. But it is absolutely *realistic* to believe that 100% of self-motivated people will become demotivated under Draconian systems designed to increase accountability.


Anonymous said...

More Facebook comments:

Evan, Paul and Rick,
Isn't also possible, and ideal, to have the positive/trusting atmosphere and accountability to each other as well as having accountability to the organization? I absolutely agree with the principles you discuss in your post, but I don't necessarily believe that these are mutually exclusive with having institutional accountability.

These varied approaches may work more easily depending on the type or organization, or size of the organization, but verbalization of specific accountability standards (even if minimal) seem to be helpful to provide the framework upon which innovation and progress can be built. As long as these standards are met, the way in which the 'bar is raised' can occur by various methods, and as you mention, some may very well be more communal, self-perpetuating and effective than other, more paternalistic approaches. Motivation is tricky, and works differently for different people, but perhaps room for both approaches simultaneously leads to a more structurally sound, sustainable and progressive organization?

Rick: Paul and Evan, You both are absolutely correct. I guess a more accurate way to frame our situation here is trying to figure out is how far do we go in setting up systems of accountability before we start negatively affecting morale. We want to have both - but we don't want to slip into, as Evan puts it, paternalistic methods of control. It is striking that balance in our unique group which presents the challenge.

John: Your post has me thinking about the intersection of accountability and the organizational motivation. Is it easier to achieve a high degree of accountability in a company whose mission has a "higher purpose" than one whose purpose is purely commercial? Or does the corporation's mission simply impose a different set of requirements on managers who must use other tools to call forth accountable behavior from each employee?

In any case your analogy of manager as soccer coach is apt. If the manager or executive's job is more about contribution than direction then they are giving others the tools and motivation to produce a better result for themselves and the organization they are part of.

Jim Conway said...

As I read through these illuminating posts (there you go again, making me think!) I am reminded of two important contributions. The first is that of Avedis Donabedian who reminded us years ago: "First Comes Love and Passion, then comes strategies and tactics." We can never accomplish the later without the former.

The second is the important work of the Dana-Farber Cancer Institute in their Principles of a Fair and Just Culture (1) a very thoughtful consideration of this topic, drawn from the best thinking and then further enhanced.

Jim Conway


Anonymous said...

It would seem the issues are the same no matter what field you are in:


Vanessa said...

I commit myself to organizations like BIDMC because I share its values. I am proud of its aspirations, accomplishments, and legacy SO that's why I hold myself accountable.

Anonymous said...

I do not see a disconnect between teaching/coaching and accountability. If properly administered accountability closes the loop on performance. However whether you are a coach or a CEO you must first lay the ground work, which can be painstaking, before you get to accountability. Many coaches and CEOs want to jump over those steps and short cut the process. In addition, knowing your role in an organization, treating people with respect/dignity and giving recognition do not contradict with holding individuals accountable. Not everyone is the same in terms of self awareness of their own performance nor how they would even define high performance.