Accountability. It’s a word we hear often in healthcare and business organizations, what does it mean? According to BusinessDictionary.com it means “The obligation of an individual or organization to account for its activities, accept responsibility for them, and to disclose the results in a transparent manner. It also includes the responsibility for money or other entrusted property.” You as a healthcare finance professional are accountable for various aspects of money as well as ensuring that people are managed effectively to yield best outcomes and judicious use of your organization’s limited resources.I started my career in the predominantly male dominated industries of aerospace and technology. Leaders may not have been friendly or compassionate, but they got things done and held people accountable. When I moved into healthcare in 2005, it was astonishing how many leaders (predominantly women) came from heart, wanted to be friendly and have staff like them. That’s important, employees want to be liked and respected. However, as the Director of Talent and Organizational Effectiveness, I started hearing from the senior executives that many of these leaders were not holding people accountable. I provided executive coaching to a few challenged directors and learned there were some common themes. Leaders were very concerned their people might not like them if they held them accountable for things like being on time, fulfilling all their duties, etc. One director, Mary felt that people would jump ship if they had to live up to a standard of expectations, and she was concerned about turnover. She had been a peer to her direct reports and found it difficult to confront them if they were rude to a patient or colleague, didn’t turn reports in on time or failed to do their jobs in other ways. One of the key lessons you’ve hopefully learned as a leader is that you need to balance relationships with results. Holding everyone accountable means that your high performers will stay; they often leave because it frustrates them to work hard when others are not held to the same standard. Holding everyone accountable means your department will achieve better results, whether that translates to better patient care, increased revenue, improved cash on hand, etc. In healthcare whether you are working for a for profit, not for profit or government organization, we all have the identical challenge, “no margin, no mission.”Names have been changed to protect confidentiality.