ACCOUNTABILITY

HISTORY
Concept of accountability is not new.
Public expectations of the need for auditing of official expenditure (one form of
accountability) was evident in Athens as long as 400 B.C.
Although nurses were legally accountable from 1919 with passing of Nurses Registration Act.
With time, obedience &importance of following orders was stressed in nursing.
Concept of accountability has evolved over the years i.e.
Regular reporting to explanation of actions & outcomes.
Justification of values informing actions & outcomes
ACCOUNTABILITY
Being free to act.
Being obliged to give an account of ones actions.
Being capable of giving an account.
Being responsible for ones own actions.
Being capable of accepting the consequences of ones own actions.
NURSING ACCOUNTABILITY
ACCOUNTABILITY is an obligation to accept responsibility or to account for ones actions to
achieve desired outcomes. Accountability resides in role & can never be delegated away.
Accountability is always about the outcomes, not process, which are simply the means
through which outcomes are achieved.
Porter OGrady & Wilson.
According to Blacks Law Dictionary, Accountability is defined as the state of being
responsible & answerable
Mc Farlane in 1987,developed her argument by saying that accountability implies decision
making about nursing care based on sound knowledge & the standards & criteria
She also made a statement that predates the shift towards multidisciplinary decision making
by saying that. enabling the clinical nurse to be responsible relates very closely to the way
in which we organize nursing care. If it is organized along the lines of task assignment &
routines & procedures, the nurse can not take discretionary decisions & act on them. She
cannot be accountable. Only if the nurse is involved in informed decision making about
patient care which is planned & implemented on an individualized basis she can be
accountable.
According to Hunt, there are Upward accountability: it implies looking up the line & doing
what the managers & administrators require.
Lateral accountability: it implies to self regulation, in which practitioners are accountable to
& judged by the criteria set by the peers.
Downward accountability: it implies to public accountability in which staff is accountable to
the patients.
According to Dewar (1999);
Administrative line: Organizations are accountable to the government.
Professional line:Clinicians are accountable to the organizations that regulate their
profession.
Inspection line:Between government & independent inspectors

TYPES OF ACCOUNTABILITY
According to Leat,
Fiscal accountability: deals with financial probity & the ability to trace & adequately explain
expenditure.
Process accountability: Concerned with the use of proper procedures.
Programme accountability:concerned with the activities undertaken & their quality.
Priorities accountability:deals with the relevance or appropriateness of chosen activities.

Nursing accountability:-
Employment accountability
Social accountability
Ethical accountability
Professional accountability
Legal accountability
SOCIAL ACCOUNTABILITY:-Sets the norms for acceptable behavior within the society
According to WHO, Four values are:
o Relevance
o Quality
o Cost-effectiveness
o Equity in service
ETHICAL ACCOUNTABILITY:
Ethical structure are important in health.
Ethical rules form part of accountability in nursing.
Ethical accountability may be set by rules decided by society that cover everyone.
Society may allow conscientious objections to some activities in health
Relates to moral obligations.
Stresses values & principles identified with various ethical approaches such as:
Duty based
Consequences based
Virtue based
Principle based
Emotive
LEGAL ACCOUNTABILITY
Law is a major area of accountability.
Law is a set of rules, regulations & cases that provide interpretation of the rules &
regulations which apply to society.
Two systems of law:
Civil law
Criminal law
Each system has its own rules & its own court system.
Civil law:
Includes arrangement in area such as family law, employment law & in areas such as
negligence & consent.
Includes disputes between staff & the employer
Involves paying compensation.
Criminal law:
Includes rules set by the Parliament to be followed every member of the society.
Deals with the issues such as
medication,
fertility treatment,
suicide,
organ & tissue donation,
mental health &
Decision about health care
Criminal accountability(contd.)
Criminal law sanctions may involves fines & imprisonment.
EMPLOYMENT ACCOUNTABILITY
Another source of accountability
Contract of employment sets out the responsibilities & rights for the nurse & the employer.
Job description may give more detail & set out the extent of the nurses role
Protocols & policies may set out specific activities in employment relationship.
Disciplinary measures can be taken by each party in employment relationship.
Range from warning through a dismissal.
PROFESSIONAL ACCOUNTABILITY
At heart of nursing practice.
Creates principles of conduct.
Allows the nurses to work within the framework of practice.
Regulatory body for nurses & midwives.
Currently known as Nursing & Midwifery Council (NMC).
Function of NMC:
To create the limits on professional accountability in nursing & midwives practice.
NMC Code of Professional Conduct Clause 1.3 states that
You are personally accountable for your practice. This means that you are
answerable for your actions & omissions, regardless of advice or directions
from another professional.
NMC Code of Professional Conduct is personal to every nurse & midwife.
Relationship between nurse or midwife & NMC is a personal & cannot be delegated to
another nurse or midwife.


Breach of duty is considered to occur if the nurse performs an unauthorized act, fails to act or
carries out an unauthorized act improperly.
If a nurse found guilty of a breach of duty, he or she may lose his or her license or be a defendant in a
malpractice law suit
ACCOUNTABILITY & NURSINGS PROFESSIONAL BODIES
Before 2002, UKCC had been the professional regulatory body for nurses, midwives & health
visitors.
First edition published in 1983 the code of professional conduct
Confusing clauses in the exercise of professional accountability were
Work in a collaborative & co-operative manner with other health care professionals
& recognize & respect their particular contributions within the health care team
Have regard to the environment of care & its physical, psychological & social effects
on the patients & also to the adequacy of resources & make known to appropriate persons or
authorities any circumstances which could place patients in jeopardy against safe standards
of practice.
(clause 10)
Have regards to the work load of & the pressures on professional colleagues & subordinates
& take appropriate action if these are seen to be such as to constitute abuse of the individual
practitioner or to jeopardize the safe standards of practice.
(clause 11)
In response to this, UKCC published Exercising Accountability which provide central focus of
the Code-
accountability is an integral part of professional practice, since in the course of
practice, the practitioner has to make judgments in a wide variety of circumstances
& be answerable for those judgments.
Two major issues in Exercising Accountability
Primacy of interest of patients
The exercise by each practitioner of personal professional accountability in such a
manner as to respect the primacy of those interests.
SUMMARY OF THE PRINCIPLES AGAINST WHICH TO EXERCISE ACCOUNTABILITY
Interest of the patient are paramount.
Professional accountability must be exercised in such a manner as to ensure the primacy of
the patient is respected.
The exercise of accountability requires the practitioner to seek to achieve & maintain high standards
Advocacy on behalf of patients .
Role of other persons in the delivery of health care to patient.
Public trust & confidence in the profession.
Each registered nurse must be able to justify any action taken in course of her professional practice
Accomplishing a culture of accountability, requires both individual & joint responsibility.
Leaders role to focus on removing barrier
Staffs role to embrace the concept, model behaviors & spread key learning.
Joint accountability is established by
-building systems
-documentation to avoid missed steps.

PROVERB
Ahako a he iti, he pounamu
Though it is little it is special