Accountability focus and nurses' performance: A moderated-mediation model by using experiment design simulations.

Area of Science:

• Nursing
• Organizational Psychology
• Human Factors Engineering

Background:

• Accountability focus is crucial in healthcare for performance and safety.
• Previous research yielded ambiguous findings on whether process or outcome accountability better motivates nurses.
• Understanding the interplay between accountability, task complexity, and nurse strain is vital.

Purpose of the Study:

• To test a moderated-mediation model of how accountability focus impacts nurse performance.
• To determine the circumstances under which process- or outcome-accountability focus is most effective.
• To investigate the mediating role of nurse strain in the accountability-performance relationship.

Main Methods:

• A randomized controlled trial using screen-based simulations of medication administration.
• Participants were nurses randomly assigned to six experimental conditions.
• Data collected included validated questionnaires on strain and performance checklists.

Main Results:

• Task complexity moderated the relationship between accountability focus and strain.
• Process accountability reduced strain in high-complexity tasks; outcome accountability reduced strain in low-complexity tasks.
• Any accountability focus improved performance and reduced strain compared to no focus, with strain mediating the effect.

Conclusions:

• Both process and outcome accountability focus enhance nurse performance and reduce strain compared to no accountability.
• The optimal accountability focus depends on task complexity.
• Nurse managers can strategically use accountability to balance strain and performance.