How to Improve Accountability in Healthcare in 6 Steps

Considering the life-and-death situations that the NHS and other healthcare providers deal with on a daily basis, there is no sector of society where accountability is so important. By ensuring that all stakeholders understand their specific responsibilities within the organisation and their legal requirements, you help them perform their tasks to the standards expected by service users and the government. 

However, achieving accountability in healthcare is a complex task that requires collaboration, transparency and robustly defined processes. This article explains what accountability looks like in the UK’s NHS and how to improve it across a healthcare organisation. 

NHS’ definition of accountability

The NHS defines accountability in its code of accountability for boards. It says that boards in the NHS have six functions for which they are responsible. These are:

  • setting the strategic direction of the organisation within the overall policies and

priorities of the Government and the NHS, define its annual and long-term

objectives and agree on plans to achieve them,

  • overseeing the delivery of planned results by monitoring performance against

objectives and ensuring corrective action is taken when necessary,

  • ensuring effective financial stewardship through value for money, financial control and financial planning and strategy,
  • ensuring that high standards of corporate governance and personal behaviour are maintained in the conduct of the business of the whole organisation,
  • handling the appointment, appraisal and remuneration of senior executives and
  • ensuring that there is an effective dialogue between the organisation and the local

community on its plans and performance and that these are responsive to the

community's needs.

In order to achieve these objectives, a board must present financial and other information clearly, make the decisions that are within its remit and establish targets to ensure it meets the required standards for performance and quality. In addition, it must have systems in place to delegate work to executives and monitor their performance, as well as creating audit and remuneration committees. 

The NHS and accountability in healthcare

Following the introduction of the Health and Care Act 2022, the NHS formalised integrated care systems (ICS) around the country, tasking them with improving health and social care. They now run as legal entities with statutory powers and responsibilities. Here are the four key areas in which accountability is essential in the healthcare sector, as highlighted below. 

Area of accountabilityExplanation
AimsICSs and their integrated care boards (ICB) and integrated care partnerships (ICP) are accountable for:
Improving outcomes in healthcare and health in generalReducing inequalities in patient outcomes, experience and accessImproving productivity and delivering value for moneyWorking with the NHS to improve social and economic development.
PartnershipsA key element of the way ICSs run is the partnerships within them. Members of the ICP include local authorities, voluntary organisations and other stakeholders. 
Together, they provide a diverse range of experience and expertise that, through collaboration, can deliver on the aims of the ICS. 
Patients and carersIn order to ensure that decisions are taken at the right level and that they are the best decisions, engaging patients and carers is essential. 
ICSs should solicit opinions from a range of stakeholders, and as service users, patients and carers are uniquely placed to offer insights that drive better decision-making. 
CQC assessmentsAttaining a well-led rating from the Care Quality Commission (CQC) shows that the ICS is implementing the NHS England governance guidelines in the correct, transparent and accountable manner.  

Six steps to improve accountability in healthcare

Step 1: Establish clear expectations and standards

You can only hold stakeholders accountable if there is a clear framework in place to which they must adhere. This means setting expectations for their performance and minimum standards for the quality of their work. 

Clearly define each professional’s role and responsibilities, as well as their performance benchmarks and key performance indicators (KPI), so they understand what their ultimate goal is in their position and what represents the right path for their job. 

Of course, in an organisation like the NHS, there are not only requirements at a local level, but also national policies and protocols that you must communicate to all stakeholders so they can perform to the best of their ability. 

Step 2: Instil a culture of transparency and accountability

There can be no accountability without transparency. A transparent organisation is one that fosters trust and encourages stakeholders to take responsibility for their actions. This, in turn, creates a culture of accountability.  

By sharing concerns, insights and suggestions with partners, an ICS can develop solutions to issues and agree on a unified approach to mitigating problems by sharing the benefits of their expertise. 

Without a transparent approach, the collective cannot make the best possible decisions because it is working in the dark to some extent. In order to create the best possible service, it is as important for the collective to know what isn’t working as much as it is to know what is working.

Implement an open-door policy where anyone is free to share their input without fear of recrimination. Encourage staff to take part in the decision-making process and show them how their ideas help form the policy. 

Step 3: Implement robust education programmes

Healthcare doesn’t stand still, and that means that you must maintain regular training and education sessions. With advances in technology, healthcare research and best practices, it is important to keep staff up to date with the latest developments. 

Without full training on relevant areas of healthcare and clinical governance, it is not possible to hold stakeholders accountable, showing that accountability works both ways. The individual has to commit to accountability, but the organisation must also provide the optimal environment in which true accountability can flourish. 

Within your training programmes, ensure you include sessions to help employees and executives develop competencies that promote responsible and ethical conduct. 

Step 4: Leverage technology to improve accountability

In a digital world where the capabilities of artificial intelligence (AI) are developing at a lightning-fast pace, there has never been a better opportunity to use technology to your and your service users’ advantage. 

AI can analyse large amounts of data on your behalf, helping you monitor healthcare processes to track your progress towards your KPIs, evaluate your quality of care and identify any concerning trends before they become endemic. 

In addition, using a meeting portal helps your stakeholders collaborate before a meeting, facilitating open discussions on important topics that lead to better-informed debate and discussion when they get around the table. iBabs allows you to capture and track the progress of action items to hold the assignees accountable for carrying out their delegated duties. 

Step 5: Develop feedback mechanisms

Requesting feedback from patients, carers, staff and other stakeholders is the ultimate display of accountability as long as you act on that feedback and use it to streamline and improve your services. 

Management can work hard to understand the intricacies and elements of all aspects of their organisation through research and observation. However, it is incredibly powerful and useful to hear from those people who understand the system from within because they experience it on a daily basis and have an impression of what is working and what is not.

Carry out audits on the aspects flagged in feedback surveys both to ensure that high-quality services maintain their standards and to monitor improvement. Show employees and service users that you value their opinion by addressing the concerns that they express. 

Step 6: Foster collaborative partnerships

The NHS governance guidelines have collaboration at their very heart. Each ICP should contain a range of different stakeholders, each of whom brings the benefit of their skills and expertise to the table. 

These system partners share decision-making and planning, pool resources, take collective responsibility for managing risks and ensure that the ICP delivers the improvements it needs to meet the targets in its five-year plan. 


How can public engagement improve accountability in healthcare?

By engaging the public, the organisation shows that it values their opinion and that it is proactively looking for ways to improve its service. However, it not only proves accountability if the service acts on the feedback, but it also indicates how it uses the input to inform better decision-making, improve patient care and enhance other aspects of the service. 

What are some challenges to the future of accountability in the NHS?

The NHS is moving towards a model where promoting the prevention of illness helps to ease pressure on the system. However, ICSs have to balance this goal with the immediate challenges of a system in which the service is stretched from treating illnesses and there is little slack in the system to help it implement prevention policies effectively. 

What is the relationship between transparency and accountability in the NHS?

Transparency is a key aspect of accountability in the NHS. It involves openly sharing information about the performance and decision-making processes of the NHS. By being transparent, the NHS allows patients, the public and other stakeholders to hold it accountable for its actions.


Transparency and accountability are two methods by which service providers can improve accountability in the NHS. Another key element is the training and education of all stakeholders to ensure they understand best practices and current trends in healthcare. 

Technology, such as iBabs’ meeting portal, also plays an important role in this process. iBabs allows attendees to prepare more easily by holding all important information within one app and facilitating better collaboration. By recording action points and tracking progress towards their completion, iBabs helps strengthen accountability and transparency within your healthcare organisation. Request a demo today to learn more.

References and further reading

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