title: Organizational responses to accountability requirements: Do we get what we expect?
abstract: In health care, accountability is being championed as a promising approach to meeting the dual imperatives of improving care quality while managing constrained budgets.
  
  
  
  Few studies focus on public sector organizations' responsiveness to government imperatives for accountability. We applied and adapted a theory of organizational responsiveness to community care agencies operating in Ontario, Canada, asking the question: What is the array of realized organizational responses to government-imposed accountability requirements among community agencies that receive public funds to provide home and community care?
  
  
  
  A sequential complementary mixed methods approach was used. It gathered data through a survey of 114 home and community care organizations in Ontario and interviews with 20 key informants representing 13 home and community care agencies and four government agencies. It generated findings using a parallel mixed analysis technique.
  
  
  
  In addition to responses predicted by the theory, we found that organizations engage in active, as well as passive, forms of compliance; we refer to this response as internal modification in which internal policies, practices, and/or procedures are changed to meet accountability requirements. We also found that environmental factors, such as the presence of an association representing organizational interests, can influence bargaining tactics.
  
  
  
  Our study helps us to better understand the range of likely responses to accountability requirements and is a first step toward encouraging the development of accountability frameworks that favor positive outcomes for organizations and those holding them to account. Tailoring agreements to organizational environments, aligning perceived compliance with behaviors that encourage improved performance, and allowing for flexibility in accountability arrangements are suggested strategies to support beneficial outcomes.
authors.affiliation: Carolyn Steele Gray, PhD, is Postdoctorall Fellow, Institute of Health Policy, Management and Evaluation, University of Toronto and Bridgepoint Collaboratory: Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, Canada. Whitney Berta, PhD, is Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. Raisa Deber, PhD, is Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada, and Director, CIHR Team in Community Care and Health Human Resources, Canadian Institutes of Health Research, Ottawa. Janet Lum, PhD, is Professor and Associate Dean of Arts, Research Graduate Studies, Ryerson University, and Co-Chair, Canadian Research Network for Care in the Community, Toronto, Ontario.
authors.forename: Carolyn Steele
authors.initials: CS
authors.lastname: Gray
authors.forename: Whitney
authors.initials: W
authors.lastname: Berta
authors.forename: Raisa
authors.initials: R
authors.lastname: Deber
authors.forename: Janet
authors.initials: J
authors.lastname: Lum
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration; D033161:Government Regulation; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration; D006801:Humans; D017146:Models, Organizational; D009864:Ontario; D017150:Public Sector; D011785:Quality Assurance, Health Care / Q000191:economics / Q000379:methods* / Q000458:organization & administration*; D012941:Social Responsibility; D011795:Surveys and Questionnaires