Flynn Maureen Alice, Brennan Niamh M
Health Services Executive, Dublin, Ireland.
University College Dublin, Dublin, Ireland.
J Health Organ Manag. 2021 Aug 24;ahead-of-print(ahead-of-print):228-44. doi: 10.1108/JHOM-03-2021-0116.
The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction between formal "imposed accountability" and front-line "felt accountability". From these insights, the paper introduces an emergent concept, "grounded accountability".
DESIGN/METHODOLOGY/APPROACH: Interviews are conducted with 41 clinicians, managers and governors in two large academic hospitals. The authors ask interviewees to recall a critical clinical incident as a focus for elucidating their experiences of and observation on the practice of accountability.
Accountability emerges from the front-line, on-the-ground. Together, clinicians, managers and governors co-construct accountability. Less attention is paid to cost, blame, legal processes or personal reputation. Money and other accountability assumptions in business do not always apply in a hospital setting.
ORIGINALITY/VALUE: The authors propose the concept of co-constructed "grounded accountability" comprising interrelationships between the concept's three constituent themes of front-line staff's felt accountability, along with grounded engagement by managers/governors, supported by a culture of openness.
本文探讨了受访者对高风险生死攸关的医院环境中临床治理问责制的见解。分析借鉴了正式的“强制问责制”与一线的“感知问责制”之间的区别。基于这些见解，本文引入了一个新出现的概念——“扎根问责制”。
设计/方法/途径：对两家大型学术医院的41名临床医生、管理人员和理事进行了访谈。作者要求受访者回忆一个关键临床事件，以此为重点来阐明他们对问责制实践的经历和观察。
问责制源自一线实际情况。临床医生、管理人员和理事共同构建问责制。对成本、指责、法律程序或个人声誉的关注较少。商业中的金钱及其他问责假设在医院环境中并不总是适用。
原创性/价值：作者提出了共同构建的“扎根问责制”这一概念，它由该概念的三个构成主题之间的相互关系组成，这三个主题分别是一线工作人员的感知问责制、管理人员/理事的扎根参与以及以开放文化为支撑。
