Dissertationen zum Thema „Accountability“

To ensure optimal patient care an especially high level of accountability is required when entering the workforce. The purpose of this qualitative study was to explore, describe, and define perceptions of accountability as described by sophomore and senior nursing students in two baccalaureate nursing programs. The research questions aimed to (a) define what it means to be accountable as a student in general and a nursing student in particular (b) describe the importance of accountability to the profession of nursing (c) describe the circumstances and conditions that demand accountability, and (d) engage in actions that promote self-accountability. After obtaining IRB approval, the researcher explained the study to the sophomore and senior nursing students who agreed to participate in the research. Eighteen participants were interviewed.

Six questions were asked during interviews conducted to investigate perceptions of accountability. Content analysis was used to discern the essence of the narratives, from which nine themes emerged. The nine themes identified are: Difficulty defining accountability and the interchangeable use of the terms; accountability and responsibility; emerging knowledge; focus on work of nursing; student attention to tasks and outcomes; motivation/self-discipline; student stress and sources of stress; conditions for accountability and responsibility, and faculty actions; and promoting self-accountability and accountability to others.

Study findings suggested that this group of students understood the importance of accountability but were unable to verbalize a definition, often confusing accountability with responsibility. Students perceived that faculty played a role in their academic success; students also promoted accountability in faculty and in peers who were less successful academically.

Democratic regimes have developed numerous institutions to enhance accountability through procedures that formally and informally probe public officials’ actions. The ongoing expansion of public evidence available to citizens has strengthened their ability to judge the performance of public officials. However, this increase in “investigative power” cannot be analyzed without regard for the structural cost of searching, sorting, and putting information to work to adjudicate open inquiries. Political accountability is tested in increasingly more sophisticated strategic settings where the principal's success in scrutinizing the agents depends both on the evidence made available and on the effort expended on investigation.

This work analyzes some of the main mechanisms that underlie these institutions. In chapter 2, I develop a model of endogenous information acquisition where politicians can choose how much evidence to disclose after taking a suspicious action. The model focuses on the effects of the open-ended nature of political investigations – they may uncover misdeeds related or unrelated to the event that triggered them – and sheds light on the previously unexplained nature of cover-up in political settings, including the presence of incentives for good incumbents to withhold as much information as possible from the investigative bodies. Chapter 3 studies the behavioral plausibility of these findings in a laboratory setting.

Chapter 4 is focused more on informal probing institutions, such as the continuous scrutiny of politicians through and by the media. The model explicitly differentiates between the quality of information (linked to the likelihood of producing dispositive results) and the cost associated with processing this information (linked to the resources needed to put it to use). One of the main results of this analysis is that citizens of democracies with lower cost of information may optimally choose to be less informed.

School accountability policies were created in response to concerns that the United States was under-performing and losing its position as an international leader in education. These policies are currently an integral part of the American educational system. The effectiveness of school accountability policies, however, remains unclear and research on how performance-based accountability is related to principal behavior is largely undeveloped. This dissertation examined the relationships between performance-based school accountability and the behaviors of school principals. Using a nationally-representative database of public elementary schools (the Schools and Staffing Survey 2003-04), this dissertation explored the associations between different aspects of performance-based educational policy on principal work engagement, supportive leadership, and shared instructional leadership. Findings suggest that most associations between performance-based rewards and interventions and principal behaviors are negligible or negative. State policy for rewards had a negative association with supportive leadership, and state policy for intervention had a negative association with principal engagement. Among schools meeting all performance goals in the previous academic year, nearly all of the associations were statistically negligible; the only significant association was that between exposure to school-wide monetary rewards and principal engagement. Specifically, exposure to school-wide monetary reward had a significant negative association with principal engagement. Among schools failing to meet all performance goals in the previous academic year, exposure to intervention was negatively related to all three principal behaviors and three associations were statistically significant. Specifically, exposure to evaluation cycle was associated with significantly less supportive leadership, exposure to reduced resources was associated with significantly less shared instructional leadership, as was exposure to school choice. The interactions with school size and school poverty varied by type of incentive and by principal behavior, and generally suggest that the relationships between policy and principal behavior are stable across different contexts. Findings from this dissertation resound previous concerns with present performance-driven school accountability policy and introduce a new point of concern into the argument against the practice. While negative associations between accountability policy and principal behaviors may not be deemed directly pertinent to the bottom line (i.e. student achievement), that the only significant relationships are negative is an important consideration and refutes the theory of action in accountability. Reconsideration of performance-based accountability is recommended, as neither reward nor intervention consistently related positively to principal behavior; state policy for reward and intervention, exposure to monetary rewards, and exposure to nearly all interventions were negatively related to at least one principal behavior.

In 2014, more than 1.6 million patients received services across the U.S. from hospice care agencies. The teams within these agencies are supporting each other to play a vital role in assisting a person’s transition from this life to the next comfortably, as well as catering to the family. Hospice care companies are comprised of a variety of roles that are divided into teams. Staff members vary in age from 21 to 70 years, indicating the presence of mixed-generation teams. Generational diversity can create challenges in understanding different points of view, learning styles, and communication. Generational differences are one of the most fundamental reasons organizations experience difficulty with recruitment, development, and retention. In seeking to develop high performing teams, the concept and practice of accountability may be helpful in keeping employees engaged and committed to their team and the organization. Given differences in perception across multiple generations and the importance of accountability, this study explores the multi-generational concepts of accountability and the role of tight knit teams in the various roles at Hospice Care of California. The results indicated that age difference does not play a significant role in accountability. However, tight knit teams are important to providing accountability within a team. The findings of this study can be used to help management and team members become more aware of generational beliefs and drivers behind accountability. This will enhance trust, commitment, clear communication, as well as create effective and productive teams in the healthcare industry.

Accountability in healthcare tends to dominate discussions focused on improving the quality of care, the experience of patients, pay-for-performance, and engaging employees to produce positive performance outcomes. Organizational leaders are held to answer to external regulatory agencies about performance outcomes based on prescribed standards. Frequently, these agencies adopt a punitive approach by imposing rewards and penalties for achieving or failing to meet the performance standards. Furthering the challenges, organizational leaders are expected to model accountability, hold employees accountable, and be a source for inspiration and motivation. The purpose of this qualitative action research study was to examine person-centered accountability (PCA), or the use of positive leadership, positive practices, and positive emotions, as a complementary approach to regulatory-centered accountability (RCA). Six workshops influenced by appreciative inquiry, a practice period, participant journals, interviews and the use of a portable biofeedback device to measure positive emotions were all utilized to develop an understanding of participant’s experiences and perceptions about the value of PCA and RCA. Participants were clinical and non-clinical leaders at a Midwest medical center. Results from this study revealed the participants’ perception about the holistic and interdependent nature of PCA and RCA. Integrating PCA and RCA requires a change in philosophies as well as day-to-day accountability practices. Leaders and employees need to use both PCA and RCA to improve performance outcomes, therefore, it is important to create an organizational reset to change beliefs about accountability, build leadership capacity, and invest in employees. Future research is needed to evaluate the long-term impact of PCA and RCA on performance outcomes in and out of healthcare.