Collective Accountability

The Problem

As the reimbursement paradigm is shifting from fee for service to Value Based Purchasing models, healthcare organizations and executives are increasingly being held accountable for improving patient engagement and satisfaction measures. No longer just a “soft” measure of performance, hospital reimbursement is now directly tied to performance in this area (for example, it is the basis for 30% of the CMS value-based purchasing program bonus). In addition, a recent survey1 indicated that more than 50% of healthcare system executives report that their incentive compensation contains a patient satisfaction component. Until now, healthcare systems have often used what we call a “cut-and-paste” method of segmented training programs, individual coaching, and “carrot-and-stick” incentives to improve performance in this area. Unfortunately, these have not produced the desired results because they have not engaged key stakeholders in a large-scale change process—the needed ingredient for sustainable culture change.
1 http://www.healthleadersmedia.com/intelligence/detail.cfm?content_id=286050&year=2012

The Solution

We focus our efforts specifically on the improvement of the HCAHPS Patient Survey measures that are now being used as a basis for the patient experience portion of the CMS Hospital Value Based Purchasing Program (VBP). Using a large-scale systems approach, we help the larger organization and their teams achieve these key outcomes:

  • Co-design of collective accountability with alignment to improving the healthcare system’s performance on the HCAHPS measures
  • A systems approach to reinforce collective accountability, identify obstacles to its achievement, and engage leadership in understanding its impact—using a “planning-to-plan” team to design the large-scale, real-time multidisciplinary session with 50 to 250 stakeholders assembled in one room over one to two days
  • A professional staff compact that would identify positive and negative behaviors, as well as demonstrate how teams carry out collective accountability in their professions and across providers
  • Feedback mechanisms that would be engaged every day to enhance the working environment and provide appropriate feedback to both reinforcers and violators of the compact
  • Data integration that augments assessment of patient experiences with clinical measures from the CMS Hospital VBP program to assure that the accountabilities and behaviors consistently support desired revenue, cost, and quality outcomes goals
  • Engaged long-term sustainability by monitoring the large-scale, real-time results over 18 months via 5-6 core teams to assure systems integration, reinforcement of results, and assessment of obstacles

The Results

We help you achieve these measurable results with evidence-based practices that align with the latest standards from HCAHPS, the CMS VBP Program, and the Joint Commission:

Opportunity for increased revenues resulting from achievement of above average HCAHPS patient satisfaction scores

Increased patient engagement such that patients achieve a more active role in their care and consequently greater opportunities for better health

Increased patient safety by reducing disruptive behaviors of professionals (from research studies including our own):

• 94% of staff work with a toxic person
• 70% to 80% of medication errors are due to disruptive behaviors of professionals (65%: nurse-to-nurse abuse; 77%: physician-to-nurse abuse)
• 31% of nurses who were targets of disruoptive behaviors quit
• Only 1% to 6% of targets of disruptive vehaviors ever filed a formal complaint
• Only 14% found feedback effective

Enhanced quality of care by professionals demonstrating “everyday civility”© of respectful engagement throughout the organization

Decreased costs associated with less time needed for performance management issues and coaching


Dr. Mitch Kusy and Dr. Elizabeth Holloway, experts in collective accountability at Zia Healthcare Consultants

Dr. Mitchell Kusy

Dr. Mitchell Kusy, a Fulbright Scholar in International Organization Development and professor at Antioch University, professor at Antioch University, Ph.D. Program in Leadership & Change, was head of leadership development for American Express and director of organization development at HealthPartners. Author of several business books, he consults in strategic planning, organization development, and the design of organizational communities of respectful engagement. He received the Minnesota Organization Development Practitioner of the Year Award in 1998. Dr. Kusy is a principal in his consulting firm and may be reached via email at mitchellkusy@gmail.com or his websiteat www.mitchellkusy.com.

Dr. Elizabeth Holloway

Dr. Elizabeth Holloway, a Fellow of the American Psychological Association and Diplomate in Professional Psychology, is a professor at Antioch University, Ph.D. Program in Leadership & Change. She was a Leadership Fellow at the University of Wisconsin-Madison and consults with leaders worldwide on systems approaches to supervision, mentoring, coaching, toxicity, and building communities of respectful engagement. She has published extensively in research and training of supervision in professional practice and incivility in at work. Dr. Holloway may be reached at elizabethlholloway@gmail.com or visit www.elizabethholloway.com