Administration and Leadership, EMS Insider

Embracing the Three Attributes of Accountability

EMS is changing rapidly in this fast-paced world of health care reform and “accountability” and “professionalism” go hand in hand as keys to success as we face many challenges.  Regardless of what job position we fill in the organization—front line care provider or leader who serves those care providers—every person must exhibit the “behaviors of accountability.” These behaviors are essential to meeting the “triple aim” of improving the patient’s experience, improving efficiency and reducing costs and bettering the health of the community at large.

We can no longer tolerate laziness and other negative behaviors in our organizations—we simply can’t afford it.  We can’t allow those who are “unaccountable” for their actions to blame others, make personal excuses for their failures and say “I can’t do that” whenever there’s a new challenge at hand. We need to recognize and develop team members who are accountable for their actions—those who acknowledge the reality of the situation they are in and embrace it, and say “I can do that” when faced with a challenge. In sum, people who engage in accountable behaviors find the solutions to move themselves and their organization in a positive direction.    

Successful and respected EMS agencies foster a “culture of accountability” that permeates all levels of the organization. But you can’t develop that culture without a commitment from everyone to make positive changes. Accountability is a personal choice that requires each person to accept their circumstances and to find ways to improve that circumstance in a positive way. 

It’s easy to forget that the business of patient care is a collaborative process where accountability is critical to positive patient outcomes and business success. Each of us must work together with other healthcare providers—regardless of our position in the organization—if we are to improve the delivery of patient care and to reduce our potential liabilities.

So, when can we call ourselves a “professional?” In my view, that won’t happen until we act as true professionals—recognizing and embracing the common duties that we all share in being accountable for the service we provide to others. To this end, there are three core “attributes of accountability” that I believe help define the consummate EMS professional:

1. We Have a Duty to Question Ourselves

The business of providing patient care requires the utmost transparency and honesty in all aspects of what we do, from the leadership to those in direct contact with the public and patients. Too much is at stake to expect anything less. Every professional must have the ability to recognize their own deficiencies particularly when confronted with a difficult situation. Constant reevaluation of our individual actions is an essential skill for the professional EMS leader or field provider. We each need to have the gumption to simply say “I need help” or “I need your advice” when we are uncertain about a course of action we’re about to engage in.

2.  We Have a Duty to Question Each Other

True professionals do not get defensive when a colleague questions something they are doing. This is another critical attribute of the EMS professional. On the street, if we observe our partner doing something wrong, we have a duty to question it and bring it their attention so that potential harm is avoided. The person receiving the criticism should welcome it rather than scoff at it. EMS agencies that regularly conduct case reviews, leadership training and engage in other roundtable discussions set the tone for this positive behavior. We must perform in a manner which shows that acknowledging mistakes and deficiencies in an open, honest and non-defensive way is the right thing to do. Questioning each other in a constructive way helps avoid serious mistakes, and can improve patient care and the effectiveness of the organization.

3.  We Have a Duty to Accept Responsibility for Our Actions/Inactions

True professionals have no problem in accepting when they have screwed up—and they learn from it. In health professions, acceptance of responsibility is essential to foster an open honest and transparent environment in which the patient is always at the forefront. Anything less than that can promote dishonesty and “covering up” of mistakes and other bad decisions. When EMS providers use phrases like “what happens in the truck stays in the truck” or “what happens on the shift stays on the shift” it is an indication that there is a potentially dishonest workplace culture. The old adage that “if you screw up I’ll cover you and if I screw up you cover me” is not only inappropriate in a healthcare setting; it’s dangerous.

There’s a great positive quote by John Baptiste Moliere (1622 – 1673): “It is not only what we do, but also what we do not do, for which we are accountable.” Not doing something we should be doing—like failing to bring all the lifesaving equipment up the three flights of steps to the patient’s side—is just as bad as doing something improperly. EMS leaders can’t look the other way. We have a duty to root out laziness, bad behaviors and call out the “unaccountable” ones. We need to help those less accountable individuals in our agency change for the good. Embracing the three attributes of accountability can go a long way toward empowering and “professionalizing” every member of your EMS agency.