Accountability in Healthcare Organizations and Systems

Abstract

Accountability regimes in healthcare systems thus face numerous challenges relating to the definition of a clear mandate in the form of specific goals and objectives, to the attribution of these mandates to skillful providers or organizations and to the design of incentives to support the accountability relationship and improvement. The goals are related to the complex function of production (integration of care, caring for multi-morbidity chronic diseases, improving the health of the population), and they will command a broad set of competencies and knowledge on the part of governing bodies and providers, plus an ability to collaborate for the improvement of care and services. While accountability is challenging and critical to the improvement of health systems (at least within the context of the Canadian healthcare system), we do not have much systematic research dealing with this issue. In this special issue of Healthcare Policy/Politiques de Santé, a research program under the leadership of Professor Raisa B. Deber (University of Toronto) has documented how accountability is structured within various sectors and organizations in the Ontario healthcare system. This collection of papers is very valuable because it is the first one that provides a detailed description of how accountability regimes are developed and structured across the system (e.g., the hospital sector, the long-term care sector and public health). Beyond the richness of the description of the accountability landscape in the Ontario healthcare system, this set of papers raises important issues around the theme of accountability. First, it shows that accountability is still in its infancy-not because providers or organizations do not want to be accountable or that governing bodies do not want to make them accountable , but because identifying the right targets and establishing the right mechanisms to account for the utilization of healthcare resources is a complex task. Second, these papers deal mostly with accountability regimes within the current boundaries of the system with its silos. It says almost nothing about the challenges and promises of developing accountability regimes within the context of networks or programs that transcend current professional or organizational boundaries. Finally, this collection of papers refers only marginally to the question of financial incentives, which seem to be a key lever that governing bodies use to influence the behaviours of healthcare providers and their propensity to take some goals or objectives more seriously. Having said this, the research team has done a great job based on a single research grant to produce an exhaustive mapping of how the notion of accountability is deployed across the Ontario healthcare system. This is of interest for researchers, but also for any observers of the healthcare scene across Canada, where each system faces the challenge of better aligning the utilization of resources with broad system goals commonly defined now as the Triple Aim: better quality of care, better safety of care and better health outcomes at a minimal cost.