From finger-pointing to forward-moving : How accountability can accelerate growth in the healthcare sector

Healthcare is a sector as vital as it is complex, where mistakes can have serious consequences. And yet, when dysfunctions occur, the instinctive reaction in many organizations remains the same : find someone to blame.

This blame culture, though deeply rooted in some hospital or medico-social systems, hinders innovation, progress, and the quality of care. Conversely, building a culture of accountability fosters engagement and continuous improvement.

Let’s explore why and how shifting from a management style based on assigning individual faults to an accountability-driven approach enables the healthcare sector to thrive sustainably.

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1. The blame culture : a hidden obstacle to progress

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In many healthcare institutions, errors are still perceived as individual failures.

• A file filled out incorrectly ? It’s the secretary’s fault.
• A wrongly administered medication ? It’s the nurse’s.
• A delay in the operating room ? It’s the aide or the anesthetist.

This reflex to look for “culprits” (in the accusatory sense of the word) has several consequences :

• Atmosphere of mistrust : professionals hesitate to report mistakes or share the difficulties they face.
  
  
• Withdrawal : everyone protects their own area, which harms interdisciplinary collaboration.
  
  
• Stagnation of practices : symptoms (isolated mistakes) are treated without ever addressing systemic causes.
  
  
• High turnover : under pressure, caregivers leave structures they perceive as "toxic" or unfair.
  
  

The blame culture creates a counterproductive environment, fueling tension, inefficiency, and increased risk for patients.

2. Accountability : a lever for continuous improvement

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In contrast, an accountable organization doesn’t seek to “punish” mistakes, but rather to understand their root causes to prevent recurrence.

Accountability doesn’t mean the absence of consequences. It involves :

• Clear roles and expectations
• Transparent communication
• The right to make mistakes in a safe framework
• Collective problem-solving
• Implementation of concrete improvement plans
  
  

💡 Example : In a hospital that adopts this posture, a medication dosage error becomes an opportunity for improvement:

• Review of protocols
• Simplification of documents
• Targeted training
• Revision of the prescription software
• Etc.
  
  

Result : caregivers feel heard, supported, and empowered. The organization progresses as a whole.

3. Accountability ≠ individualization !

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A common misconception is that accountability means everyone must “fend for themselves.” It’s exactly the opposite.

True accountability is based on :

• A clear and fair management framework
• Shared objectives in service of care
• Sufficient means to act (time, training, tools)
• Regular evaluation of team practices
  
  

In other words, we hold both teams and individuals accountable, by giving them the keys to succeed in their mission.

In this sense, accountability becomes a factor of cohesion: everyone knows what they must do, why they’re doing it, and how they can contribute to continuous improvement.

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• 📕Healthcare innovation leadership: why leading beyond silos is now mission-critical

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4. Concrete benefits for healthcare organizations

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Implementing a culture of accountability in the healthcare sector leads to tangible results on multiple levels :

For healthcare professionals :

• More autonomy and recognition
• Less stress and fewer conflicts
• A stronger sense of purpose

For organizations :

• Better quality of service
• Reduced turnover and absenteeism
• Stronger institutional image (accreditations, attractiveness, etc.)

For patients :

• Fewer medical errors
• Better continuity of care
• More transparency in treatment

Many international models (notably in Nordic countries, Canada, or "magnet hospitals" in the USA) show that accountability is a strategic performance driver.

5. Accountability : where to start ?

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Moving from a blame culture to one of accountability can’t be declared overnight. It requires time, a shared vision, and most importantly, a structured change management process.

Here are the key levers to activate :

1. Exemplary leadership

Leaders and managers must embody values of trust and accept their own zones of responsibility.

2. Genuine and frequent communication

Inform, listen, acknowledge efforts, share successes and failures... Internal communication becomes one of the main pillars of cultural transformation.

3. Monitoring and feedback tools

Set up practice reviews, team meetings, quality indicators, etc. These rituals support improvement without judgment.

4. Targeted skills development

Train professionals in error management, compassionate communication, teamwork, problem-solving, etc.

5. External support

Bringing in a change management consultant allows for an objective diagnosis, co-construction of realistic action plans, and sustained momentum over time.

6. The key role of change management in this transition

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As a change management consultant, I’ve found that moving toward an accountability culture is one of the most powerful - but also one of the most sensitive - changes to support. 🤔😳

This means :

• Navigating the legacy of a hierarchical, siloed culture
• Taking into account field constraints (workload, regulatory pressure)
• Engaging all stakeholders (management, caregivers, admin staff, sometimes patients)
  
  

The methodology I recommend is based on 4 core axes :

1. Participatory diagnosis : co-construct understanding of obstacles and levers
2. Shared purpose and vision : align around goals for care quality and safety
3. Local experimentation : test accountability initiatives in pilot units
4. Capitalization and scaling : expand successful practices across the organization

🎯 Goal : create an organizational framework where everyone feels like a driver of progress, not just a spectator of dysfunction. 😉

In short : fostering accountability is investing in the future of care

The healthcare system can no longer afford to operate based on fear, silence, and isolation. In the face of challenges like workforce shortages and rising quality demands, only a culture rooted in trust and collaboration can build a resilient, attractive, and high-performing healthcare system.

Shifting from blame to engagement isn’t a utopia but a strategic necessity.

And it’s a path more and more institutions are taking - provided they’re well supported, with method and conviction.

Are you a transformation leader in your healthcare institution ?
Do you want to foster a sustainable and positive culture of accountability ?

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