The worst environment for a human being to live and work in is that where there is no consequence to his actions. Facing consequences and being mindful of consequences are powerful forces that shape us for good. It is not different for organizations - when it is made clear to all members that each will be held accountable for his words and actions, a milieu is created for the gathering of responsible folks.
In HCA Hospice Care, we take the idea of accountability seriously. Accountability is intentionally built into both our culture as well as our ecosystem. And having both cultural as well as systemic principles and practices emphatically communicate the priority we accord accountability.
There are two cultural pillars that build accountability, viz transparency and truth-telling. Leaders have the responsibility to create a place where there aren't too many secrets. Where confidentiality needs to be applied (eg in personal and clinical data), only those who have reasons to know and are properly authorized can have access. Otherwise it is imperative that we make everything else accessible and known to all our stakeholders. Truth-telling involves the discipline of calling out bad or inappropriate behaviour in members of our community. We must make it natural and a good thing to address wrongful acts as soon as possible. Bad behaviour must be matched punitively. Word gets around speedily when a car cuts a traffic light and is not captured on camera; everyone will immediately know that the camera is fake or faulty. Conversely, when an errant driver is given a hefty fine for speeding, every driver drives slowly on roads with speed cameras. Wise leaders also make it a habit to catch people doing right by praising and affirming them. Such affirmative actions are even more potent when done publicly in front of colleagues.
Our HCA's accountability ecosystem rests on three pillars: whistle-blowing, risk management and audit. I think the most potent deterrence in any organization against unsavoury behaviour is a policy where anybody can report on anyone while enjoying anonymity. We communicate to our staff at HCA that they can report what they observe as wrongful behaviour to a superior or straight to the CEO or the President. No one is above the law. We make it known: you can run but you can't hide. We work with KPMG to design a multi-tiered risk management structure. It is a ground-up effort where line staff members identify risks and design appropriate mitigating factors. We review this risk structure annually to enhance its robustness. Finally, in addition to our mandatory annual internal audit, we invite and welcome auditors from our funding and regulatory agencies. Only when we are willing to cooperate with external auditors do we really get our house in order.
We suffer much tedium and inconveniences to uphold our conviction about accountability. We are comforted that it has not gone unnoticed. For three consecutive years (2016, 2017, 2018), HCA has received the Charity Transparency Awards (CTA) which recognises charities with good disclosure practices that the Charity Transparency Framework (CTF) recommends. The CTF is closely aligned to the Code of Governance for Charities and Institutions of a Public Character (IPCs), with 9 key dimensions highlighted as key areas for disclosure. And in 2018, we were also granted a special commendation award for risk management. We would have done the same even if there were no public recognition for our investment in accountability. Nothing gives us more satisfaction than when staff, volunteers, donors and regulators express confidence in us as an institute of character, an honourable organization, a noble community.
Cover photo courtesy of HCA Hospice Care