Accountability or Responsibility? The Challenge of Policies in Clinical Psychiatry

Abstract

Administrative preoccupation with policy development and political accountability may detract from professional development and personal responsibility.

The emperor’s edicts stop at the village gate

“…Key recommendations for effective policy implementation were: Policy and procedure are necessary but not sufficient conditions for improving care. Critical success factors for changing culture and practice may lie, as Dignam 3 and O'Connor et al 27 suggest, in leadership at the local level, and the effectiveness of team culture and governance processes, particularly the prevalence of a sense of personal accountability for improving the processes and outcomes of care.…”

“…The leadership style of those leading an organisation, service or team is important. ‘Policies can be imposed or “sold”, criticisms broadcast or locally explored, grievances inflamed or contained and worked through.’ 3 We favour a ‘close’ or ‘near-by’ style of transformational leadership, whereby the leadership group understands the stage and culture of the organisation and what motivates the clinicians to take responsibility for change in their own teams. 1,2,13 Too many policies, particularly if they are presented as lengthy documents without appropriate summaries of actions required, may lead to despair and confusion.…”

“…Ham 2 refers to the ‘inverted power structure’ peculiar to health organisations where ‘in these disconnected hierarchies, organisational leaders have to negotiate rather than impose new policies and practices’. As Dignam 3 says, ‘Such a belief (that clinicians read policy) is culturally common, so by definition not delusional, but in my experience it is certainly far-fetched.’ Dignam also warned that an over-reliance on policy directives as an instrument for changing practice could undermine the importance of personal responsibility for change and development.…”

Blame and Accountability 2: On Being Accountable

“…This threshold may be most appropriate in many health settings. Dignam 28 has commented on the constraints of workforce and the inevitable limitations of some individuals in a large service. He also mentions the opportunity costs of investigating too many low-level violations.…”