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.

CareerPhysician, Launch Your Career Series

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 CareerPhysician leadership conference session, our team advised the attending Chief Residents to recognize the difference between activities and results.

“Activities are what you do – actions you take that lead to results,” said Wesley Millican, CEO and Physician Talent Officer of CareerPhysician. “Results, on the other hand, are the desired and undesired outcomes of your actions or inactions.”

Most people focus on activities instead of results. We urge Chiefs to know their expected results first, then define the actions likely to achieve those results.

To reinforce this point, we 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 wrestling pose. They were instructed that the object of the game was 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.

Millican 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,” Millican 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,” Millican said. “Give me all the excuses you can think of.” The Chiefs easily supplied a list:

• “I never got the message, 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, Millican told the group.

The Blame Game

Millican 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. 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?’ 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.

You must identify the following four major steps on your way to creating accountability in your program – See it, Own it, Solve it, Do it.

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. A 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, is CEO and Physician Talent Officer of CareerPhysician, LLC, the national leader in child health faculty and executive search and leadership development. In partnership with the Child Health Advisory Council, a diverse group of emeritus and current national thought leaders in academic pediatrics, Mr. Millican provides critical career and professional development content to residents and fellows to help foster their effective transitions from training into academic and/or private practice roles. For more than 20 years, Mr. Millican and CareerPhysician’s Launch Your Career® Series has served as the trusted go to career training and ACGME Competency resource for U.S. residency and fellowship program directors, and most importantly for residents and fellows seeking to maximize their return on the personal, professional and economic investments and sacrifices made during training. Through Launch Your Career® Series onsite and visual programs and associated web-based content, Mr. Millican believes that residents and fellows are the future of academic pediatrics and that meaningful early investments in their career journey will have a monumental positive impact on their long-term professional satisfaction and their service to children.

For more information about the Launch Your Career® Series and/or to schedule a program for your residency or fellowship program, contact us.

Updated March 2024