Does Your Accountability System Need a Tune-up?

Patrice Spath, MA, RHIT

By Patrice Spath, MA, RHIT

The pandemic has disrupted the work environment and associated managerial functions—face-to-face communications with employees are now often replaced by phone or virtual conversations, for example. Basic elements of effective communication are necessary regardless of the approach. This is also true of the management function of accountability. Whether staff are working remotely or physically present in the department, effective communication is needed to ensure that everyone is aware of and expected to fulfill their job responsibilities.

There are four key elements of employee accountability: clear expectations, periodic evaluation, effective consequences, and fair-minded application. The workplace, whether remote or in person, does not have an effective accountability system without all these elements. Below are some warning signs suggesting the accountability system needs a tune-up:

  • Do you hear staff blaming other people or circumstances when things go wrong?
  • Does it seem that staff do not accept responsibility for what they do or how they do it?
  • Do staff say they feel a process is not working well but do nothing to change it?
  • Do staff act as if they expect someone else to solve problems?
  • Does it appear that staff feel more responsible for their efforts than the results?
  • Do you hear staff say, “It’s not my job or my department’s job?”
  • Do you feel that staff display a lack of personal ownership when problems arise?
  • Do staff complain, “Why should I work hard when others aren’t expected to do the same?”

If the department’s accountability system needs improving, consider what elements need attention.

Clear Expectations

People working in the health information management (HIM) department want to be successful at what they do, and this can only happen if they know what is expected of them. Responsibilities for each position in the department are usually incorporated into the job description. To clarify responsibilities, which are often broadly stated, job descriptions should also include expectations. For example, a job responsibility might be: release confidential patient information. Expectations for this responsibility can include:

  • Use two identifiers to confirm valid consent.
  • Provide only the requested documents.
  • Fulfill requests within two business days.

Clear expectations are also important for the evaluation element of accountability.

Periodic Evaluation

Routine evaluation is a critical element of the accountability system. Without it, there is no accountability. The only way to determine performance is to measure it, ideally every month. There are many strategies to evaluate employee compliance with job expectations. Whatever the method, evaluation should be as objective as possible. Formal and informal methods of performance measurement are essential to a properly functioning accountability system.

Observation of daily work is commonly used to evaluate performance for in-person workers in addition to objective measures such as “percentage of requested records provided within two business days.” Customer satisfaction surveys can be used to measure performance of employees that interact with external and internal HIM customers. For example, the customers of clinical documentation integrity (CDI) specialists (physicians, coding, case management, nursing and other caregivers) can be asked if the specialists’ interactions are helpful, timely, and respectful. This type of customer survey can be used for both in-person and remote workers. Some remote workers, such as coders, are primarily evaluated using objective measures such as “number of errors” or “number of records coded.”

The accountability system does not stop at this step regardless of how employee performance is evaluated. End results—consequences—are a vital element of the accountability system.

Effective Consequences

There should be a mechanism for taking appropriate actions based on performance evaluations results. When there are no consequences for good or poor performance, staff morale suffers.

There are two type of consequences: positive and negative. Either type can be effective for motivating employees. Positive consequences, such as recognition and career enhancement, increase compliance with work expectations and also help employees feel part of the department’s success. Rewarding good performance can also be done with positive consequences, such as free CEU opportunities or gift cards. Don’t overlook the value of personal handwritten messages in a notecard for both in-person and remote workers.

Negative consequences such as criticism and counseling also increase adherence to requirements. However, these types of consequences can cause employees to do what they need to do just to avoid punishment, and not much more.

If you are only asking employees to meet job responsibilities and expectations, positive or negative consequences may work okay. But, if you want to promote continuous improvement, positive reinforcement is the most effective consequence. Good work performance resulting from positive consequences is focused on success, not based on fear.

Expectations, evaluation, and consequences are the three components of employee accountability. The application of these components is the fourth.

Fair-Minded Application

When performance expectations are met or exceeded, employees should receive positive consequences such as recognition and praise. An environment lacking in positive consequences or reinforcement is bad for employee morale. Outstanding employee performance is not rewarded by receiving just the same percent salary increase as others. Fair-minded application of consequences means those employees exhibiting extra effort are rewarded differently from those just getting by—even if this is just a personal thank-you note recognizing the employee’s contributions.

When performance expectations are not met, the first step is to determine the underlying cause before imposing negative consequences. Fault and consequences should only be determined after carefully evaluating the situation. Negative consequences are not justified if the work system failed the employee. For example, internet connectivity problems can slow down productivity for remote workers. Performance expectations may need to be relaxed for an employee facing unexpected home-schooling responsibilities for children.

It is not desirable to default to the work system causing poor performance when the individual is clearly responsible. People who fail to meet job expectations should have some type of negative consequence. Non-disciplinary consequences include informal counseling, mentoring, or coaching and personal development (formal or informal training). In some situations, it may be necessary to move the employee to a more appropriate work assignment.

Disciplinary consequences may be needed. Application of the types of negative consequences are often spelled out in the organization’s human resources policies. The morale of employees that consistently meet expectations is adversely affected when poorly performing employees are not subjected to any negative consequences.

Don’t Overlook the Accountability System

The COVID-19 pandemic has turned the work environment upside down with more employees working remotely than ever before. This new reality requires continual monitoring of productivity and employee performance. Where necessary, tune up the department’s accountability system to maintain good employee morale and meet customer requirements.


James Reason. Managing the Risks of Organizational Accidents. Hampshire, England: Ashgate Publishing Group, 1997.

Patrice L. Spath ([email protected]) is a healthcare quality and patient safety specialist based in Forest Grove, OR and is winner of the 2020 AHIMA Distinguished Member Award.

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