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Published on: April 18, 2017
Understanding missed nursing care through felt accountability focus and task complexity: A prospective
Layla Suliman1,2, Anat Drach- Zahavy1, Hadass Goldblatt1
1The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
International Journal of Nursing Studies Advances
|March 11, 2026
Summary
Accountability focus impacts missed nursing care differently based on task complexity. Outcome accountability reduces missed care for simple tasks, while process accountability is better for complex tasks, improving patient safety.
Area of Science:
- Nursing Science
- Healthcare Management
- Organizational Psychology
Background:
- Missed nursing care is a critical indicator of compromised healthcare quality, often linked to workload and staffing issues.
- The influence of accountability focus (evaluating nurses on outcomes versus processes) on missed care remains under-explored, especially its interaction with task complexity.
Purpose of the Study:
- To investigate how task complexity moderates the relationship between nurses' perceived accountability focus and the incidence of missed nursing care.
Main Methods:
- A prospective, repeated-measures field study was conducted with 105 registered nurses across 10 hospital wards.
- Data were collected via anonymous mobile surveys over three shifts per nurse, utilizing mixed linear modeling to analyze nested data.
Main Results:
- No direct effects of task complexity or accountability focus on missed nursing care were found.
- Significant interaction effects revealed that for simple tasks, outcome accountability was linked to less missed care, whereas for complex tasks, process accountability was associated with less missed care.
Conclusions:
- Healthcare systems should tailor accountability strategies to task complexity rather than applying a uniform approach.
- Outcome accountability supports consistency in routine care, while process accountability enhances thoroughness in complex care situations, ultimately promoting safer patient care.
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