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McChrystal Group data on the healthcare industry indicate accountability needs improvement in the workplace, with employees now being 20% less likely to agree that when objectives are not met, the responsible parties are held accountable. After partnering with a leading hospital network to build trust and clear processes for decision making throughout its workforce, communication improved across teams, which in turn led to an increase in accountability throughout the system.


In this installment of our ongoing Industry Insights series, we focus on the healthcare industry. Perhaps more than any other industry, before the pandemic, healthcare and public health systems were already facing shrinking margins, growing tension in the workplace and workforce shortages. Clinician well-being was a concern among professional groups, with burnout reaching all-time highs.

In 2019, 35% to 54% of nurses and physicians had substantial symptoms of burnout, according to the  National Academy of Medicine’s (NAM) 2019 Consensus Study. Today, NAM’s recent surveys show that high-stress work environments are driving more physicians (20%) and nurses (40 %) to leave the field following two years of the pandemic. Additionally, more than 25% of workers in state and local health departments indicated they are considering leaving their organizations. Increased costs of labor and unprecedented turnover and vacancy rates coupled with inflation in services and supplies further contribute to the challenges.

Employees are now 20% less likely to agree that when objectives are not met the responsible parties are held accountable.

McChrystal Group data drawn from over 2 million data points, spanning pre- and post-pandemic, indicate that while the healthcare sector historically performs at a higher level than other industries on all variables of our engagement survey, employees are now 20% less likely to agree that when objectives are not met the responsible parties are held accountable.



Through our work with clients in the healthcare sector, McChrystal Group has identified the following trends contributing to a lack of accountability:

  • Complex nature of the ecosystem consisting of several entities and stakeholders.
  • Workforce personnel shortages and challenges, worsened by the pandemic.
  • Legacy systems with functional silos, further entrenched by the hybrid working environment.
  • Lack of clear directions, roles, and responsibilities among disparate teams.

We all understand that accountability is critical, yet considering healthcare is a vast ecosystem comprised of complex organizations that all impact each other, the requirement for accountability in the space at-large and on individual teams is heightened.

Drawn from more than a decade of field interviews and survey responses spanning hundreds of organizations and varying industries, McChrystal Group’s database presents a framework to underscore actionable insights, allowing leaders to engage their teams with intention and precision.

In recent years we have seen the healthcare industry overcome untold challenges and obstacles. People are still drawn to working in healthcare because they believe in its mission and purpose, yet those same dedicated employees want accountability. In the healthcare ecosystem, accountability works both top-down and bottom-up, and trust serves as the foundation of an accountable working environment.”

DNSc, RN, FAAN, Senior Advisor

Why It Matters

While lower levels of accountability lead to lower employee engagement and organizational trust, they also adversely impact patients and communities—the focus of any healthcare organization. In contrast, high performing teams result in safer high-quality care for patients and their families.

Leaders are ultimately responsible for their team’s results, which is where accountability begins. When leaders fail to address performance and behavioral issues within their team, it can undermine the entire group, resulting in lower quality of care provision and weak organizational culture. It can also set a dangerous precedent as team members begin to learn that there are not any real consequences for poor behavior or performance. Without accountability, engagement dips, and resentment can build among team members who are negatively impacted. Leaders lose their credibility, and top performers leave.

The reality is that most employees want accountability. More than 90% of respondents in a survey of 40,000 for the  Workplace Accountability Study said they would rank “improving the ability to hold others accountable in an effective way” as one of the top leadership development needs within their organization.

Data show nearly everyone struggles with what may be the most prevalent organizational deficiency today. Healthcare is  already suffering from high and increasing attrition and turnover. We know interprofessional collaboration is crucial to a  successful healthcare ecosystem, and collaboration can’t be achieved without a baseline level of accountability.


How We’ve Worked with Clients to Address These Challenges

NAM’s 2022  National Plan for Health Workforce Well-Being lists “create and sustain positive work and learning environments and culture” as the first of seven priorities for the industry. We posit that understanding employee and clinician perceptions of their work environment and then acting on those data are fundamental to engaging and retaining the workforce.

Creating a workplace culture with a foundation of accountability has everything to do with the organization’s underlying values and relies heavily on trust. Organizations must align around and clearly articulate goals, assign responsibility and accountability, measure results, and communicate all of these things transparently.

Our data shows organizations that demonstrate trust between front-line employees and senior leaders had a higher return on shareholder investment than organizations with prevalent distrust by 42%.

McChrystal Group partnered with a leading children’s hospital to help the leaders of a cross-functional center better understand how communication failures and siloing among functional departments led to a lack of accountability, trust, and effective operations, which ultimately could impact patient care.

Clinical staff were not trained or accustomed to working collaboratively across disciplines. When placed in leadership positions where they needed to build a strategy for the center, physicians were uncomfortable speaking up, providing constructive criticism to their peers, and struggled with prioritization.

McChrystal Group helped the center build its first-ever comprehensive strategy, which provided a roadmap for improved outcomes, financial stability, and growth across all functional disciplines. McChrystal Group facilitated cross-functional leadership team meetings where strategy execution was measured against key performance indicators, ensuring resources were distributed transparently and teams were held accountable on progress toward goals.

This cross-functional strategic planning helped the center align its day-to-day operations against a mission, vision, and values, which improved work culture and employee engagement among staff and clinicians. Physician leaders were better able to engage their administrative partners to execute strategic initiatives, thereby ensuring improved information sharing and process refinement across teams.

Following months of hands-on work with our embedded team, physician leaders reported feeling more empowered to guide the collective future of the organization rather than focusing only on their area of specialty. They had clarity about center-level priorities and objectives, which allowed them to focus scarce resources and time on projects that helped the center achieve it’s overarching goals.


This article is part of a series of industry insights utilizing McChrystal Group’s proprietary data to highlight industry-specific insights and strategies leaders can adopt to address them.

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