Published in HFMA HERe, November 2017 newsletterBy Joanne SchlosserAccountability: It’s a word we hear often in health care and business organizations, but what does it mean? According to BusinessDictionary.com, it is: “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 the best outcomes and judicious use of your organization’s limited resources.I started my career in the male-dominated industries of aerospace engineering and technology. The leaders I worked with at the time may not have been overly friendly or compassionate, but they got things done and held people accountable. When I moved into healthcare in 2005, it was astonishing to me how many leaders (predominantly female) led with their hearts and wanted to be friendly and have staff like them.Having strong relationships is important, and 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 among them.Leaders were concerned their teams 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 certain 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 I hope you’ve learned as a leader is that you need to balance relationships with results. Holding everyone accountable likely 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 health care, whether you're working for a for-profit, nonprofit, or government organization, we all face the same challenge: “No margin, no mission.”How can you ensure that you are holding your team accountable for results that matter? You can follow the lead set by Kyra, a senior manager I coached who was promoted to director and eventually into a C-suite position. She learned that to be successful, she had to create a vision and clearly communicate it to all her direct reports, who ensured they carried the message through her entire span of control. She first focused on building her executive presence to communicate clearly, accurately, and professionally. She also found many ways to engage with her team members, including by rounding, attending huddles, staff meetings, using memos on bulletin boards, and sending emails and texts to meet the communication needs of all team members.In addition, she clearly communicated her expectations for all employees and what everyone needed to do for her team and the organization to “win.” Clear expectations and goals move people in the right direction. Do your team members understand the benefits of what happens when they do the right thing? Do they understand how you need things done and by when? Do they understand the implications when they are not held accountable and how it affects the team, organization, patient, or customer? It’s your job as a leader and supervisor to connect these dots: Why is it important for people to be accountable? What benefits are derived when you hold employees and leaders accountable to do the job they were hired to do? People work harder when they can see how what they do ties to the organization's greater goals.I recently met with the executive team of a healthcare organization that had undergone significant growth during the preceding three years. During this period of growth, Jennifer was concerned that many of the executives were complaining about having lack of focus. She wanted to change their culture. They recognized that as an executive team, they had a hard time holding each other and their direct reports accountable.Plans and goals changed frequently. As a result, it was fostering mistrust. Employees were complaining about the lack of clarity and having no focus, and turnover was sky high. We decided to conduct a strategic planning retreat to focus on the upcoming year and then use a team coaching approach to hold the executives accountable to creating a focus on a few critical goals.In weekly meetings, the executives are driving to get clear on what their goals and immediate priorities are. What should they focus on, and what is less urgent? With this clarity, they can determine how best to communicate the vital goals to their teams and focus on results.There will be voluntary and involuntary turnover as the organization moves to a culture of accountability. People are attracted to an organization with a strong mission, clear goals, and a sense of where they might fit in to make a difference. One of the organization’s big changes will involve their employee selection and onboarding process, so they choose those who are a better fit with the organization’s values and goals. Accountability starts with making the right hiring, on-boarding, and training decisions. It is then strengthened with consistent messaging and expectations to ensure compliance and goal achievement. Accountability affects your success. Holding yourself and others accountable may not be easy, but it generates results that are worth celebrating.