Crucial Accountability QA

Creating a Culture of Accountability

The following article was first published on October 5, 2005.

Dear Crucial Skills,

I manage a large staff of around seventy nurses. How do I begin to change the culture from no accountability to full accountability?

We are not speaking of the patient care aspects—the staff is outstanding in this area. I’m concerned about everything else: keeping the desk area free of clutter, returning mandatory education or memos on time, noting when some problem in the unit needs attention and either ignoring it or coming to me to “fix” everything, etc. I am getting worn out and need some help with this aspect.

Thank you,

Dear Exhausted,
You are not alone! Thousands of managers and employees feel exactly the same way. Helping people deal with accountability is one of the main reasons we wrote Crucial Confrontations. Whether you work with seventy nurses or just one other person in a toll booth, you will have issues with accountability. Why? People are people and circumstances are complex. At some time, you will face a broken promise, a violated expectation, or bad behavior.

Before I answer your specific question, let me congratulate you. The core work—in your case, patient care—is going well. Other things are slipping—punctuality, paperwork, and work environment—but your challenge is not as severe as what many face (things like issues with quality or productivity where organizational survival is in question).

So to address your situation, I’ll focus first on what might be called the “non-core” gaps. A gap is the difference between what is expected and what is delivered. At the heart of your frustration and exhaustion, I imagine, is that you have been very clear about what is expected. What a clutter-free desk looks like has been clarified. Why it’s important has been articulated to the point of feeling like nagging. The same is true of the paperwork and due dates. But there is little compliance or performance. Then comes this loud, persistent, intense voice in your head that clamors, “Why can’t these people do something as simple as getting rid of the clutter? It’s clutter for heaven’s sake, not asbestos!” Sometimes this voice is so powerful that it slips out between your very own lips. For many people, this cycle occurs at home with such issues as a clean room, curfew, and toilet seats.

Given that, let me make a few suggestions.

  1. Make sure that the expectation is clear and explain up front why it is important. Often, managers or parents tell others what is expected but they don’t take a minute to help them understand why it is important or essential. Unfortunately, the implied message is, “Because I said so!” or “Because I want it.” That’s not particularly motivating or empowering. Help the other person know what the positive consequences will be if he or she follows through, and what the natural negative consequences will be if he or she doesn’t. When you talk about potential negative consequences, what you want to do is help employees see how patients or families or colleagues or even the employees themselves will be affected. What you don’t want to do is talk about imposed consequences like “writing them up.” A few moments of helping others see the “what” and the “why” can help performance.
  2. When assignments are given, even about something as simple as keeping a clear desk, make sure you are clear about who does what by when, and follow up. Often one of these aspects is not clear. Who will keep the desk uncluttered, what uncluttered looks like, when it should be done, and when you will check back should be very clear. If you leave one of these details out, the commitment or assignment is less effective.
  3. Don’t oversimplify. Treat the issue like an ability issue rather that a motivation issue. If we assume that people don’t want to do something, we often try to motivate them with power and subtle or not-so-subtle threats. Even that raised eyebrow can carry many messages. If we treat the gap like an ability issue, we ask for ideas. People close to the problem, the process, and the opportunities very often have good ideas. So ask, “What could be done to make this easier?” If others have a good, workable idea, they are more likely to follow through on it. Also, they may suggest some bottlenecks, barriers, or complexities that you are unaware of. The outcome is that you have a better solution with increased commitment.
  4. Look at the example that you and other leaders are setting. For example, consider the following situation in a home setting. A mother is consistently demanding that her daughter clean her room and her bathroom. Mom takes away television privileges until the room is clean. She grounds her daughter for the weekend until the room is clean. The daughter, in talking with her friends, wonders if her mother thinks she’s blind. Why, asks the daughter, doesn’t Mom have to clean her sink, her closet, or her bedroom? This seems like an obvious problem. And yet sometimes managers and leaders have a hard time seeing the example they are setting on issues like clutter, punctuality, paperwork, civility, communication, and even controlling costs. When accountability suffers, look to the leaders, including self.

In summary, when gaps persist, clarify what’s expected and why; make sure there’s agreement on who does what by when and follow up; ask for ideas; and look at the example that is being set.

Best wishes,