Three Accountability Systems
Three Accountability Systems
I’m sure there are more than three legal accountability systems we can use to tie performance to standards. I teach three. I want to know more. Here are the three I teach.
- Compensation.
This is the biggie. Grand-Daddy of them all. MVI has taught this for years, and it works. Offer a bump for performance to standards—both quality standards and performance standards. It doesn’t help you if the nurse makes 22 visits, but half of them are bad. Then provide a way for employees, on a department or team level, to share in the savings when they beat their target “budget” based on percentage of net patient revenue. If we hold people to standards, this one works time and time again. But in some states, this isn’t legal. So what’s left? - Annoyance.
Yep, if we create a system that annoys our staff when they are out of standard, we can reel them in. It works with most people, not all. Here’s an example: Early on, when we help a Hospice implement their Model, we ask the compliance person, “What are the two or three simple things that drive you crazy?” They almost always give us simple things like entering visit orders, inconsistencies on measurable data, or not completing their documentation the same day. That sort of thing. We ask them to make a quick self-learning-module with a test and pop it up on Relias, or their learning management system. We ask that all clinicians complete the module once. Then EVERY TIME they fail to perform as taught, we reassign the module and the test. We annoy them until it’s easier to do it right, than to do it wrong. - Embarrassment.
Sometimes this works. Sometimes not. We’ve always taught that reports like the team-location report should be all together, so that all team managers can see other team managers results. It brings a bit of perspective and bit of competition into play. I worked with on organization where the team managers were required to bring in a 50% contribution margin. A reasonable standard for that organization. They monthly “report card” was shown to all team managers. Three beat their target, two were close, and one was woefully under. Was she embarrassed enough to fix her problems? The jury is still out.
If you know of other accountability systems, please let us know! (One Hospice, a faith-based organization, told me they take people “out back for flogging”. They were kidding. I think.)
