Grounded accountability in life-and-death high-consequence healthcare settings

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".

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.

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.