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ACCOUNTABILITY: What Motivates Employees. Session Objectives. This session will consider Accountability :. What it is . What we want . How to get it. Accountability: Is this it?. 1. Accountability: What it is.

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accountability what motivates employees

ACCOUNTABILITY:What Motivates Employees.

session objectives
Session Objectives

This session will consider Accountability:

  • What it is.
  • What we want.
  • How to get it.

1. Accountability: What it is

A definition of “accountability”:

“Personal choice and willingness to contribute to an expressed or implied outcome.”

A question:

“How do you make people accountable for their health?”


1. Accountability: What it is

Potential problems with this question:

  • Can we “instill” accountability?
  • Accountability only enables negative feedback after a decision or action.
  • Does best evidence and practice support that programs can “make people accountable”?

2. Accountability: What we want

A better question:

“What motivates employee ‘personal choice and willingness to contribute’ to health?”

Specifically, what is the evidence and are we applying it in our programs?


3. Accountability: How to get it

Two Worldviews on How to Get It


3. Accountability: How to get it

1. The Deficit Worldview


3. Accountability: How to get it

  • They don’t see (e.g., denial, lack of insight)
  • They don’t know
  • They don’t know how
  • They don’t care

The problem is (an empty glass):


3. Accountability: How to get it

Thus, the solution is (to fill the glass) by giving them:

  • Insight: If you can just make people see, then they will change
  • Knowledge: If people just know enough, then they will change
  • Skills: If you can just teach people how to change, then they will do it
  • Hell: If you can just make people feel bador afraid enough, they will change

3. Accountability: How to get it

Just published study (BMJ, May 26): Salter and colleagues analyzed pharmacist-patient discourse during medication review consultations.

What they found: Advice giving without being asked was common and “was often resisted or rejected (by patients) and created interactional difficulties…”.

What about accountability: Advice giving occurred “despite deliberate displays of competence and knowledge by patients.”


3. Accountability: How to get it

2. The Competence Worldview


3. Accountability: How to get it

The solution is (to draw water from the well) by:

  • Asking for their insight
  • Evoking their knowledge
  • Assuming that patients have skills
  • Enhancing self-efficacy

3. Accountability: How to get it

What do Competence Worldview

programs look like?

A clinical example:

Motivational Interviewing


Motivational Interviewing

Rubak and colleagues (2005) in the British Journal of General Practice concluded from a review of 72 RCTs:

“(Motivational interviewing) outperforms traditional advice giving in approximately 80% studies…The meta-analysis shows significant effects of motivational interviewing for combined effect estimates of body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content…on many different areas of intervention. The review has shown that motivational interviewing can be effective even in brief encounters of only 15 minutes and that more than one encounter with a patient increases the likelihood of effect.


…MI & Medication RCTs

Aliotta, S. L., Vlasnik, J. J., & Delor, B. (2004). Enhancing adherence to long-term medical therapy: A new approach to assessing and treating patients. Advances in Therapy, 21, 214-231.

Bennett, J. A., Perrin, N. A., & Hanson, G. (2005). Healthy aging demonstration project: Nurse coaching for behavior change in older adults. Research in Nursing and Health, 28, 187-197.

Berger, B. A., Liang, H., & Hudmon, K. S. (2005). Evaluation of software-based telephone counseling to enhance medication persistency among patients with multiple sclerosis. Journal of the American Pharmacists Association, 45, 466-472.

Broers, S., Smets, E. M. A., Bindels, P., Evertsz, F. B., Calff, M., & DeHaes, H. (2005). Training general practitioners in behavior change counseling to improve asthma medication adherence. Patient Education and Counseling, 58, 279-287.

Hayward, P., Chan, N., Kemp, R., & Youle, S. (1995). Medication self-management: A preliminary report on an intervention to improve medication compliance. Journal of Mental Health, 4, 511-518.

Kreman, R., Yates, B. C., Agrawal, S., Fiandt, K., Briner, W., & Shurmur, S. (2006). The effects of motivational interviewing on physiological outcomes. Applied Nursing Research, 19, 167-170.

Robles, R. R., Reyes, J. C., Colon, H. M., Sahai, H., Marrero, C. A., Matos, T. D., et al. (2004). Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: A randomized controlled trial. Journal of Substance Abuse Treatment, 27, 145-152.

Rose, J., & Walker, S. (2000). Working with a man who has Prader-Willi syndrome and his support staff using motivational principles. Behavioural and Cognitive Psychotherapy, 28, 293-302.


Other competence-based programs

Other programs that can be “competence” based:

  • Financial Incentive
  • Physician initiated, written action plans
  • Communication training for patients
  • Reminders (e.g., letters, alarms, telephone)
  • Self-monitoring

Competence-based Principles

The Principles of ChangeTM

1. The Principle of Social InvestmentTM

2. The Principle of DiscrepancyTM

3. The Principle of AccessibilityTM

4. The Principle of ExpectancyTM


3. Accountability: How to get it

What You can Do: Communicate this…

Accountability programs (whether to motivate patient adherence or a healthy lifestyle) work, not because they demand or instil accountability, but because they value and evoke employee competence and commitment.

behavior change solutions inc
Behavior Change Solutions, Inc.

Grant Corbett


Behavior Change Solutions, Inc.

52 Cherie Road

St. Catharines, ON


Tel: 905-937-1441

Fax: 905-937-5858