Your year as Chief Resident or Senior fellow offers a wealth of opportunities for establishing life-long work habits and philosophies that can sustain a fruitful and successful medical career.  One of the most important skills to cultivate is a commitment to a culture of accountability.

In the simplest terms, accountability is about driving positive results in the workplace.  But from an individual, professional standpoint it is about taking ownership of and control over the processes that create that success.  Creating and nurturing a culture of accountability in your program is one of the most important keys to driving that success.

At a recent CareerPhysician leadership conference session, Jon Rand, Vice President of Partners in Leadership advised the attending Chief Residents in Ophthalmology to recognize the difference between activities and results.

“Activities are what you do – actions you take that lead to results,” he said. “Results, on the other hand, are the desired and undesired outcomes of your actions or inactions.”

Most people focus on activities instead of results, according to Rand. He urged the Chiefs to know their expected results first, then define the actions likely to achieve those results.

To reinforce this point, Rand asked the Chiefs to play a game. Two partners stood facing each other, right feet together, grasping each other’s right hand – like a standing arm wrestle pose. They were instructed that the object of the game is to win and that a point would be scored whenever one person’s hand was pushed back to his or her side.

Results among the pairs differed widely. One pair earned zero points because each individual struggled ferociously to prevent the other party from scoring a point. Another pair scored twenty points because they quickly realized that by cooperating and easily pushing each other’s hands back and forth they were, in fact, achieving the desired result.

Rand pointed out that, while it’s human nature to believe that for me to win, someone else has to lose, creation of a “win-win” scenario is a more efficient way to achieve the desired result.

“When you’re faced with a problem or difficult situation, it’s easy to make excuses,” Rand told the Chief Residents. He asked them to imagine a situation in which they have made a serious mistake, and perhaps now are facing a review board, with their position in the program in jeopardy.

“Now the result you’re looking for here is to keep your job,” Rand said. “Give me all the excuses you can think of.” The Chiefs easily supplied a list:

•    “I never got the memo or email or phone call, so I didn’t know.”
•    “I wasn’t even there, I had other obligations.”
•    “There were several ways to do this, but I didn’t know which one you wanted.”
•    “It’s not my job.”
•    “I was TOLD to do it this way.”
•    “We usually have the first-years do it.”
•    “The nurse made a mistake.”
•    “The patient didn’t give me an accurate history.”

Playing the “blame game” or fashioning creative excuses is not the best way to achieve the desired result of keeping your job, or of establishing your reputation as a leader, Rand told the group.
The Blame Game
Rand offered this list of the trouble indicators that reveal whether you or your program colleagues are playing the “blame game” instead of being accountable for your actions:

•    Cover your tail
•    Wait and see
•    “It’s not my job.”
•    Ignore/deny
•    Finger pointing
•    Confusion – “Tell me what to do.”

If you find yourself or your fellow workers taking this approach to problem resolution you can be sure that you’re not working together towards driving the success that comes from an accountability culture.
Steps to Accountability
Accountability is the key to leadership, according to Rand. “If we define the goal as the best possible result, what’s the best way to achieve that goal?”

“The typical question is ‘who’s responsible for failure?’” said Rand. “The real question should be ‘who’s responsible for achieving the result?’ Make a personal choice to rise above circumstances and demonstrate the ownership necessary to achieve the desired result,” he advised.

Rand identifies the following four major steps you must take on your way to creating accountability in your program – See it, Own it, Solve it, Do it.

He describes them as follows:

See it
Be open to the perspectives of others;  be open and candid in your communications; ask for and receive feedback; be ready to hear the hard things necessary to see the reality of a situation.

Own It
Get personally invested in your program; learn from both successes and failures;  align your approach to work with the expected results of your organization;  act on the feedback you receive.

Solve It
Always ask yourself – “what else can I do?”; overcome cross-functional boundaries;  deal creatively with obstacles; take the necessary risks.

Do It
Focus on the top priorities and do what you say you will do; don’t blame others; create an environment of trust.

Winning Results
Remember that accountability is a means – not an end.  If you commit to accountability as a management, communications and business process you will drive successful results into your program.

You have one year as a Chief to create new values in your program by dedicating yourself to the accountability culture.  You have the potential not only for paving the way to an enduring and rewarding professional career in healthcare, but also to create a program that will serve as a model for others to follow and emulate.

An ophthalmology program based upon the accountability principles discussed here will be a magnet for other residents and Chiefs who will be similarly motivated in the future to take advantage of these secrets of success.

About the Author:

Wesley D. Millican, MBA, CEO and Physician Talent Officer of CareerPhysician Advisors, LP, and CareerPhysician, LLC, provides comprehensive talent solutions for academic children’s hospitals, colleges of medicine and academic medical centers across the nation. He possesses a longstanding passion for career development of all young physicians and serves as a go to career resource for training program directors and their residents and fellows. In continuing his commitment to the “future of medicine”, Mr. Millican speaks nationally at residency and fellowship programs. His Launch Your Career® Series is a proven resource for today’s residents and fellows and has served as a go to resource for program directors over the last 15 years.