101: Accountability


Steps to bring accountability into your private practice.

By Sturdy McKee, PT

We are moving toward payment systems with shared risks, quality measures, and increased accountabilities. Although some systems were designed with more subjective than objective accountabilities, there will be a continued movement toward measuring outcomes and patient satisfaction. We are moving away from payment systems, at least when looking at CMS (Centers for Medicare & Medicaid Services) that pay for activity and not results. But while this evolution is taking place around us, many of us work in environments where accountabilities are not made clear.

Accountability starts with what you, in your job role, and your employees, in theirs, are expected to deliver and how you and they will be measured. This can take many forms. Key performance indicators (KPIs), job accountabilities—things you do or don’t do—and core values or behaviors are a few examples. For a physical therapist, units per visit; visits per case; and visits per day, week, or month are examples of KPIs that might be used to define and measure success. For people working the front desk, KPIs might be percent of copay collections, or conversion rate: the number of new patients evaluated divided by the number of incoming leads or referrals. Examples of job accountability for a physical therapist are compliant documentation and adherence to HIPAA (the Health Insurance Portability and Accountability Act).


These are not really optional, as 90 percent–compliant documentation, or a single HIPAA breach, would be considered unacceptable. And then there are behaviors that we expect like courtesy, professionalism, and empathy. Creating a system to measure these behaviors and provide frequent feedback to employees is preferable to subjective assessment reviewed annually.

Many physical therapy companies lack a clear, written description of accountabilities for each role. The owners or managers might have some idea of what they expect, but the communication and structure may be lacking. Employees don’t have enough clarity around what their primary job is. If you ask your front desk person what their job is, you might get a long and rambling list. Or do you get a clear and concise response like “to schedule patients and collect copays”? The other things on the list might technically be parts of their job, but do they matter if the top two items are not delivered? If we don’t schedule patients, then all the faxing in the world doesn’t matter.

Articulating these things for each position in your organization is a great first step. It invites a conversation with your team members. The conversation will illuminate differences in your expectations and your team members’ perceptions and expectations. An example of how you can begin this process and keep it simple is to create a grid of the top five things you require in that job role (see table). Having a discussion around this and ensuring clarity is key to your team members’ success.


Why is any of this important? It creates a visual aid with real data that is helpful for seeing patterns and tracking progress. It helps give your team clarity. And in doing so, it reduces the emotion around performance, raises, and time off, to name a few examples. It makes your conversations easier. According to Andrew Ritchie of Results.com, “One of the biggest problems management has is simply communicating with employees in a constructive manner. So often, it seems, a manager’s best efforts at coaching can be misconstrued as unfair criticism or even as a personal attack.” Having clear and measurable accountabilities and expectations allows for the potential to shift that conversation, too. The manager can position themselves as the advocate, trying to help their team members achieve success. When employees have clarity, and have agreed to the accountabilities for the position, the conversation can shift to “How can I help?”, “What resources do you need?”, and “What can we do to make sure you succeed?” Instead of being perceived as unwanted criticism, the dialogue can become one of teamwork, cooperation, and advocacy.

We are moving inexorably toward external cultures of accountability. As businesses, we will be held to performance metrics and deliverables in order to get paid. Without internal cultures of accountability, how can we hope to succeed in future in these external environments of accountability?

Sturdy McKee, PT, is a physical therapist, business coach, and advisor who can be reached at www.SturdyMcKee.com or @Sturdy.