Leading with love: learning and shared accountability

To describe peer learning and shared accountability and their use within our management system to improve the rate of patient annual wellness visits completed by primary care physicians.

Our management system implements programs to improve performance on a measure, initially declaring the goal, roles and responsibilities. In the illustrative case in this article, primary care physicians are assigned the goal of completing annual wellness visits for 65% of their patients by the end of 2021. To support physicians, peer learning networks are established, connecting teams, physicians and others to broadly share best practices and support better performance. Shared accountability means higher-level leaders in the organization need to first set lower-level leaders up to succeed before holding lower-level leaders accountable for achieving the declared goal. Our shared accountability model describes processes of the higher-level leader to ensure lower-leader success. The accountability process if a lower-level leader does not improve performance involves 3 steps: (1) a letter; (2) meeting with hospital executives for peer review; (3) review for sanctions/disciplinary action.

In quarter 1 of calendar year 2021, we identified 30 physicians that were behind pace for reaching the 65% goal of AWVs with patients for 2021 and also had not achieved the 2020 60% goal. After step 1, 22 of 30 (73%) physicians were on target for the goal. After step 2, 3 of 8 physicians were on target for the goal.

Peer learning and shared accountability are underdeveloped in health care, and often viewed as at odds with each other. In our framework we integrate them. Thus, we formed learning networks, connecting every level of the organization and branching out across the health system to share ideas and build capability. Our shared accountability model removes the punitive connotation often connected to accountability by aligning higher and lower-level leaders to work together as a team. This model is improving personal performance among primary care physicians, and now being used for all quality and value efforts in our health system. We believe if broadly applied, this model could help improve value in health care.