THE DANGERS OF NONACCOUNTABILITY
Susan Gallagher, RN PhD
Celebration Institute, Inc
susangallagher@hotmail.com
susan@celebrationinstitute.com
WHAT IS ACCOUNTABILITY IN
THE HEALTHCARE SETTING?
PURPOSE
 Recognize
the dangers of nonaccountability
 Hand washing – the most basic
 Carrot and stick
 Understand the threat of organizational
dysfunction
 Putting it all together
DANGERS OF NON-ACCOUNTABILITY
Annual cost exceeds $9 billion
 Annual rate of underreporting is 50 – 96%
 Exceeds the total rate of MVA, general and
commercial aviation crashes, suicide, falls,
drowning and poisoning
 Misunderstanding the “near miss”

Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and
Social Causes. CRC Press: Boca Raton. 2012
HAND WASHING – THE MOST BASIC
“I notice you always wash your hands after we
play. Frankly I find that quite offensive.”
HAND WASHING – THE MOST BASIC
“ There are billions of germs, bacteria and microbes
living on my body, and I still feel so alone!”
HAND WASHING – THE MOST BASIC
Employees MUST NOT wash their hands before
returning to work.
HAND WASHING – THE MOST BASIC
“I use so much alcohol-based hand sanitizer, my
hands had to join a 12-step program.”
“Wait, this one’s s a lawyer. We better wash our
hands.”
HAND WASHING – THE MOST BASIC
It is not funny!
 Symptom of a bigger issue

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Infection is the #1 reason for mortality among
hospitalized infants
Antibiotics lend a false sense of security
Gels do not control all infectious agents
Annual rate of hospital-acquired infection – 1.7
million
99,000 deaths related to hospital-acquired infections
each year
Hand-washing is the primary deterrent to
hospital-acquired infection
Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social
Causes. CRC Press: Boca Raton. 2012
WE KNOW THE FACTS
Viruses and bacteria can live from 20 minutes to
two hours or more on such surfaces as cafeteria
tables, doorknobs and desks
 Eighty percent of all infectious diseases are
transmitted by touch
 Ninety-five percent of the population say that
they wash their hands after using a public toilet.
However when 8,000 people were monitored
across five large cities in the US, they found the
actual number to be more like 67%

http://www.hardydiagnostics.com/articles/hand-washing.pdf
WE KNOW THE FACTS
One study demonstrated that hand washing
guidelines were followed 25% of the time during
times when the floor was overcrowded and
understaffed. Compliance rose to 70% when the
floor was properly staffed and not overcrowded
with patients.
http://www.hardydiagnostics.com/articles/hand-washing.pdf
WE KNOW THE FACTS
A poll of pediatric ICU physicians showed that
they claimed their rate of hand washing between
patients was 73%, but when followed and
observed, the hand washing rate was found to be
less than 10%.
 A recent study showed that 21% of the health
care workers in ICU had varying counts of
Staphylococcus aureus on their hands

http://www.hardydiagnostics.com/articles/hand-washing.pdf
HAND WASHING – THE MOST BASIC
Hand-washing facilities that are adequate and
convenient
 Time enough to adequately hand wash, clean the
healthcare environment, and also bathe patients
 Effective equipment such as quality gloves,
gowns that fit, and soaps and towels that do not
threaten skin integrity
 Enough equipment to use for isolated patients
 Employer-based pens, stethoscopes, clothing and
shoe covers

Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social
Causes. CRC Press: Boca Raton. 2012
HAND WASHING – THE MOST BASIC
Adequate staffing in all departments, including
infection control, housekeeping , sterile
processing, and direct care staff members
 Effective cleaning with chemicals that are easy to
use properly
 Effective isolation practices
 Furnishings simple to clean
 Sick policies which are not punitive

Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social
Causes. CRC Press: Boca Raton. 2012
NON-ACCOUNTABILITY IS KILLING
PATIENTS
Fifty percent of all health complications are
associated with hospital-acquired infections
 Five percent of all admissions are effected
 One death every six minutes!


Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and
Social Causes. CRC Press: Boca Raton. 2012
CARROT AND STICK
The parable of the carrot and the stick
 Must refocus on sustaining meaningful long-term
momentum for accountability
 The role of teamwork
 What is a bully, and how does this impact
accountability?

Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the
debate. JSPHM. 2013;3(1).
Center for the American Nurses Association. Lateral Violence and Bullying Fact Sheet.
Accessed May 12, 2012 at:
http://www.centerforamericannurses.org/associations/9102/files/LATERALVIOLENCEBUL
LYINGFACTSHEET.pdf
BULLYING AND ACCOUNTABILITY
Thirty-eight percent of healthcare workers report
incidents of one or more types of bullying
 Forty-eight percent report verbal abuse
 Workers who experience bullying have
significantly lower levels of job satisfaction,
increased job-induced stress, and a greater intent
to leave a position
 Fifty-three percent of student nurses report
bullying behavior by a staff nurse
 Additional adverse outcomes have included poor
morale, decreased productivity, and increased
errors

Center for the American Nurses Association. Lateral Violence and Bullying Fact Sheet.
Accessed May 12, 2012 at:
http://www.centerforamericannurses.org/associations/9102/files/LATERALVIOLENCEBUL
LYINGFACTSHEET.pdf
WHEN THINGS GO WRONG

Recognizing the need for a Crucial Conversation
Opinions vary
• Stakes are high
• Emotions run strong
•

Understanding the autonomic nervous system
Reactions of others
 Reaction of self
 Evolution through time – fight or flight!

Gallagher SM, Steadman A, Gallagher SM. Tackling tough conversations: recognizing societal
bias as a barrier to crucial conversation. Bariatric Times. 2010;7(6):1, 24 – 28.
MAKING IT HAPPEN
Gallagher SM, Steadman A, Gallagher SM. Tackling
tough topics: recognizing societal bias as a barrier to
crucial conversation. Bariatric Times. 2010;7(6):1, 24 –
28.
THREAT OF ORGANIZATIONAL DYSFUNCTION
Constant state of change
 Imbalance in funding
 Frontline care team members not included in
decision-making
 Unclear guidelines
 Poor communication
 Fail to seek innovative solutions

Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate.
JSPHM. 2013;3(1).
PUTTING IT ALL TOGETHER


Must have the following in place:
 Influential leadership
 Innovation
 Supportive workplace
How is this accomplished?
Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate. JSPHM.
2013;3(1).
PUTTING IT ALL TOGETHER – PRACTICAL
IDEAS
Do team members feel their contributions are
essential to the organization?
 …involved in facility decisions, especially where
his contribution makes a difference?
 …consulted before making any decision
impacting her position?
 …helped in his own development initiatives as
well as those designed by the organization?
 …evaluations are based on accountability?

Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate.
JSPHM. 2013;3(1).
CONCLUSION