Benefits Helps to reduce mismanagement of resources Increase utilization of CPGs (clinical practice guidelines) and evidenced-based medicine Improve

patient care outcomes Improve quality of care Ultimately create a continuous learning organization Decrease in staff absenteeism and fewer turnover rates because staff feel empowered and listened The shared savings program, mostly found in the US, gives additional reimbursement to implement a model of accountability In the long term may help to reduce cost Higher employee morale and satisfaction (the link between accountability and engagement is especially noticeable among top performing staff, as they desire a work environment where others also regularly perform at the highest levels) Promotes collaborative, coordinated care across multiple providersconverts fragmented care into integrated care Focusing on accountability creates a culture containing clear expectations, autonomy, and highly skilled coworkers When a culture of accountability is felt throughout the organization frontline staff do not lack clarity and wonder which unit goals are the most important and which warrant the most attention Many nurses are not comfortable speaking up to peers and discussing their performance and patient care. In fact, national data shows, on average, nurses are more likely to provide feedback to physicians than fellow nurses. When a culture of accountability is well instilled throughout the organization frontline staff know how to speak to each other and are not hesitant to flag problems or suboptimal care The Advisory Board Company, 2011; OHagan & Persaud, 2009; Bennett, 2012; Berry, 2014.

Limitations Supporting infrastructure must be in place Inadequate information systems and out of date technology, incompatible across different units Building peer accountability at the frontline level takes time to achieve No systematic way to capture data. Data analysis is at its infancy in Canada Communication systems fail to provide for sufficient downward or lateral information dissemination Insufficient or lack of incentives offered by Human Resource systems to physicians or other staff to commit time and effort for improvement of projects, such as error reporting Elevated start up cost

Fostering a culture of teamwork is not always easy to achieve especially in hospitals known to be highly structured and bureaucratic in nature

Giokas & Mair, 2013; Bennett, 2012; OHagan & Persaud, 2009; Berry, 2014; Senior & Swailes 2010