title: The Puck Stops Here: Taking Organizational Accountability Seriously.
abstract: This commentary presents an ethical argument and practical suggestions for holding health administrators accountable for quality improvement efforts and results. Using hockey analogies and drawing on evidence from various studies and literature in organizational ethics, it argues that health leaders must promote system performance by ensuring that there is a well-organized delivery system around patients' episodes of care and that all personnel are performing at an acceptable level. Informed by system transformation and successes in the UK, this commentary proposes four strategies to hold leaders accountable: require leaders to be familiar with front-line operations, adopt a service-line approach, evaluate organizational performance by analyzing and publicizing outcome metrics and utilize outcome-based incentives.
authors.affiliation: Chief of Foot and Ankle, San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, CA, USA, is a Canadian-trained orthopaedic surgeon with academic interests in patient education and health policy as it pertains to quality and value. His research presently focuses on the third bucket of healthcare-exploring strategies to deliver healthcare more effectively.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pinney
authors.affiliation: Associate professor, Centre for Applied Ethics, University of British Columbia, associate professor and director of undergraduate ethics curriculum, Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, senior researcher, Providence Health Care, specializes in clinical ethics, particularly as they intersect with organizational and health system issues. Her work on ethical issues in healthcare decision-making has been supported by both the Social Sciences and Humanities Research Council and the Canadian Institutes of Health Research.
authors.forename: Anita
authors.initials: A
authors.lastname: Ho
mesh_terms: D002170:Canada; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D007857:Leadership; D017146:Models, Organizational; D015279:Organizational Culture; D061214:Patient Safety; D058996:Quality Improvement / Q000941:ethics* / Q000458:organization & administration*; D011787:Quality of Health Care; D012941:Social Responsibility; D006113:United Kingdom