6 critical elements to build EMS system accountability

Accountability must occur at all levels of an organization, be tied to strategic goals and involve an ongoing process of evaluation and adjustment


By Roxanne Shanks

Accountability is the obligation of an individual or organization to accept responsibility for one’s actions and to disclose results in a transparent manner. In order to be a high-reliability organization, you need to ensure you have accountability at every level. It should start with leadership as a solid foundation and then move to the staff as a natural progression.

Here are six critical elements to building accountability into your EMS system:

1. Transparent evaluation system

Develop an organization-wide evaluation system that encourages objective accountability. Organization, leadership and staff goals should not be made in a silo, nor should they be secret. To be successful and drive performance, an organization must establish an accountability system that is transparent at all levels. Whether this is done with an online tool or posted on communication boards in the office, progress toward organizational, team and individual goals should be updated regularly and accessible and visible to everyone in the organization.

2. Strategic plan deployment

Strategic plans should be deployed to all levels of the organization on an annual basis. One mistake many organizations make is not to hold every level accountable to contributing to the overall mission. The strategic plan needs to be clearly communicated, ensuring you provide the reasons each strategy is a priority. Telling the "why" helps you articulate the mission, vision and values, and how each goal and strategy is aligned with the organization’s purpose.

Too often strategic plans focus on "what" an organization is doing, instead of "why" an organization is doing things. This is a very distinct difference when trying to connect to purpose and gain buy-in.

3. Goal development

Develop goals that are specific, measurable and aligned with the organizational strategies and outcomes. To ensure focus, no leader should have more than four to six goals, and staff should have no more than two to three goals annually.  

Each goal should be weighted (or prioritized), so the actions and time allocated to working on this goal can be aligned accordingly. For example, if you have a goal that is worth 50 percent of your total score, this should help set priorities on how you spend your time. To take it a step further, align the goals to the financial incentives of the leadership and staff.

To have true accountability in your system, it is time to move away from competency-based evaluations for which everyone receives a raise, to accountability for specific outcomes that are going to move your organization forward.

4. Goal deployment

Often organizations do a great job of planning and setting goals, but where they fail is in the deployment and execution of the plan. It is imperative to communicate the goals clearly to personnel at all levels of the organization.

You must ensure that everyone has a big-picture view and common understanding of the organizational values and direction, and how their individual actions and roles contribute to the greater good. The leaders and staff should be fully engaged in this process by helping determine what their individual and team goals will be.

5. Evaluation of progress

Now that the goals have been deployed you must monitor progress on a regular basis. This evaluation should occur at least monthly for leadership and quarterly for staff. This will ensure that variances are recognized in a timely manner and addressed rapidly. Employees shouldn’t be surprised with the feedback they receive at their annual evaluation if they are being held accountable all year, through regular monitoring and feedback.

6. Develop 90-day plans

If the evaluation process identifies goals that are not being met, develop a 90-day plan of the actions to move toward the desired outcome; who is responsible for each action, and during what timeframe it will be completed. These detailed plans are critical in creating focus for the leaders to ensure their activities are aligned with what they are trying to accomplish.

Finally, leaders need to look at how they spend their time. With each activity, meeting, phone call or email you need to ask, "How does this contribute to what I am trying to accomplish during this 90-day period?" This helps move from a mindset of "putting out fires," to proactive planning.

Organizations that incorporate these six elements into their system will have a much more aligned approach that will allow for true accountability and transparency.

About the Author

Roxanne Shanks, RRT, MBA, FABC, is a senior associate at Fitch & Associates. She serves as the CEO for LifeFlight Eagle Air Medical Program in Kansas City, Mo., and as the executive director for the Association of Critical Care Transport in Platte City, Mo. Roxanne has an extensive background in health care leadership with more than 20 years of experience in progressively responsible clinical and leadership roles within an integrated delivery system. She can be reached at rshanks@lifeflighteagle.org

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