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02nd December 2011

Accountability and Job Descriptions

Accountability is a concept which permeates all of our lives. We are all individually accountable to the State, our partners and families, employers, and society as a whole. There are not many actions which we undertake which do not have some level of accountability to someone or something, even if it is only a requirement to do no harm, lest we be accountable for that.

There is one problem with accountability; everyone thinks they know it when they see it, but definitions abound.  Everyone seems to have a different one.  One general purpose definition of accountability, courtesy of is:

“The obligation of an individual or organisation to account for its activities, accept responsibility for them, and to disclose the results in a transparent manner. It also includes the responsibility for money or other entrusted property.”

Another, health related definition from the Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders is:  “responsibility for one's own actions; this is a principle of professional practice that is obligatory for health care providers”.

Yet another, from Mosby's Dental Dictionary, 2nd edition. © 2008 Elsevier, Inc, is: an obligation to periodically disclose appropriate information in adequate detail and consistent form to all contractually involved parties.

The middle definition is the one which probably describes the understanding of most people working in health and social care .  We are all professionals, in that in order to be effective we must work within a framework of rules and regulations, carry out our work diligently and honestly, and work as part of a team with the aim of providing the best service for our clients that we are capable of producing.  That applies to the qualified members of the team, such as social workers and nurses, because everyone recognises them as “professionals”, but just as much applies to the other essential members of the service; the health and social care assistants, cleaners, caterers, maintenance staff, administrators, and everyone else without whose “professional” work the service would be less good than it should be.

In a similar manner to the dreaded “health and safety”, accountability can be a dampening effect on day to day operations and a cause of stress.  The word is most often heard in the negative context – “you should not have done that, I am accountable for it” or a variation is a pervading chant in healthcare in particular, and to some extent social care.  Managers in particular appear to be most at risk of a feeling of stress and imposition caused by their accountability, a feeling which may be caused by their belief that, in the final analysis, they are accountable for everything and everyone.

Is this really the case?  Certainly, managers are held accountable by the registration and inspection bodies for the legal compliance and satisfactory operation of day to day services.  But that is not to say that they are permanent risk of unexpected censure.  The responsibilty of the manager in this context is to design and operate a management system which is fit for the purpose of delivering that legal compliance and the satisfactory operation of day to day services, by all of the people involved in doing so, at all times.  Those managers who feel the most stressed by their accountability may be those who do not have a clear picture in their mind of how their management system works.  For instance, how often do we hear a manager with good caring skills, proven over many years of hands-on care, extolling the virtue of leadership by example.  “If I am seen to be doing it properly, they all know how to do it properly” is the guiding principle of this style of management.  It is very laudable, and true as far as it goes, but incomplete.  First of all, subordinates spend the vast majority of their time out of sight of the manager especially in home care, and transmission of the manager’s standards by a form of osmosis is a slow and patchy process. Secondly, in what context is the subordinate supposed to match the manager’s standards?  The manager is the manager – they are perceived to have, and actually have, much power and authority.  The subordinate by definition does not have as much of either, and many will feel that they have none.  So what happens when a subordinate meets a novel situation, which the manager has not been seen to cope with.  Or sees a situation where someone else carries out an operation which has a negative impact on the ability to produce a good service?  The operation of these factors, and many others, undermine the “do it like I do” style of leadership to produce the kind of variable, sometimes good but sometimes awful, service so often seen and which is totally unsatisfactory to be a part of, leading to stress, backbiting, tense interactions which are bound to impact on service users, and unnecessary staff turnover.

The training philosophy of the organisation or manager will also have an impact.  The “do it like I do” manager will often make use of the “watch Mary” style of training, that is, no formal training but new employees are expected to pick up skills and attitudes from an experienced member of staff.  The trouble is that much of that training will happen behind closed doors, and the manager has no control whatsoever on its content or effectiveness.  The outcome is a lottery.  In particular the manager cannot call on the defence of having an appropriate management system when something goes wrong.  There is no system here at all, only expediency.

An added complication arises when professionally qualified staff are in the mix, working side by side with staff who may be trained and certified, but are not members of a recognised professional body.  The most usual examples in health and social care are nurses and social workers, both of whom are members of a professional body who maintain their registration and licence them to work under their designation.  This system imposes a split responsibility on those professionals; they have a responsibility to the professional code of conduct(s) of their registration body, as well as to their employer, and through them, the care service registration body.  This split responsibility is sometimes a cause of tension, when the requirements of the employer conflict with the code of conduct. After all, the employer is not subject to the code of conduct, and it is difficult to see where the responsibility for maintaining congruence between codes of conduct and other legal constraints lies.  The main cause for tension is however the feeling of nurses in particular that they are personally at risk from the actions of those who work around them and who are not part of their profession.

The common theme to each of these issues, all of which give rise to risk, service quality variation, and feelings of personal risk and stress, is context.  Everyone works within a context. Where the manager or organisation has not set out a clear context for working, then the individual employee will develop their own context.  If a whole workforce fills in the vacuum in that way, the result is bound to be chaos, with overlapping personal contexts causing conflict, but more seriously there will be gaps which no-one wants to fill, but which need to be filled, and which will cause disaster at some time, probably quite quickly.

There are elements to “context”.  One of the most important is the boring old job description.  It is almost certain that any care service will have job descriptions, and most will have them for every job type in the organisation.  They will have found it hard to maintain registration without them.  However, in some organisations job descriptions are regarded as a bureaucratic imposition, rather than as the essential and fundamental management tool which they are.  A well designed job description is not a list of tasks to be carried out by that function.  If a task list is developed and used in isolation, who has the time, or the expertise, to make sure that the sum of all job descriptions does not miss any required functions, or duplicate others, while also meeting the overall legal, contractual and professional obligations of the organisation?  And how does that job description help an employee meeting a novel situation, with no-one available to ask how to respond before a decision is required?  Task list oriented job descriptions are the antithesis to empowerment and encouragement of skilled employees, and are not supportive of a service which is developing its expertise and quality.

The development of job descriptions is a strategic process, not an administrative one.  What is first required is the creation of a framework which applies to all employees in all situations, and which follows and supports the goals or mission, call it what you will, of the organisation.  The strategic job description is also carefully crafted to support and develop the culture of the organisation.  Following on from the creation of this strategic template, the organisation can move on to creating a set of parallel job descriptions, based on the same template, but now describing particular functional objectives, for instance social care, catering, administration etc., and picking up and adding in issues and requirements which relate to that function only.  Finally, each functional template can be further developed to reflect the hierarchy of management responsibility within that function, for instance senior carer and carer, defining that relationship and what responsibilities each level has to the other.  Take care during this process to ensure that inter-level relationships and responsibilities are the same or similar in each function, or tensions will arise.  If developed in this way, the full set will be congruent, and far more likely to be complete, eliminating overlaps and gaps, and addressing issues such as fairness and load distribution.

A particular issue which affects some services is that of the professionally qualified staff, such as nurses and social workers.  The organisation must choose how they are used in management terms in order to avoid tensions.  Take for example a nurse.  Is the nurse used as a shift supervisor/manager, overseeing other functions such as social carers, or as a health care expert working alongside social care staff such as carers?  If the nurse is used as a supervisor, do they have the relevant management training and skills, and are they also managing the other functions such as administration?  If they are not managing auxiliary functions, who is?  If they are however defined and used as heath care experts working alongside other employees, and not “in charge”, what are the overall management arrangements?  These matters are often not logically thought out and implemented, and it is this confusion which most often leads to the professionally qualified staff feeling at risk and not in control of their working life.

If job descriptions are developed in the manner described, and fully deployed, that is, they are issued and used and not issued and filed, then all employees know the context within which they work, its scope and its limitations, and their personal responsibilities.  In an environment where everyone knows their context, personal accountability for actions becomes part of natural everyday working, and not an imposed and unwelcome responsibility.  The manager can then demonstrate that they have a system which is soundly based and which supports their personal responsibility to employer and regulator, and which forms the basis for the training programme.  The manager in particular has a defence in the event that an employee does not meet their responsibilities as set out in the job description, that the employee must shoulder or share the personal accountability for their action or inaction.

The production of a strategically designed job description set which fully integrates job descriptions amongst themselves without repetition or omission, relates fully to corporate objectives, legal constraints, contractual requirements and cultural issues, while leaving room for employees to display and use their skills to positive effect in all situations, is a mammoth task.  It is a task which is beyond most small and medium sized care organisations, which is why many use the Quality Compliance Systems Ltd management system.  The job description set in the QCS system was designed from the ground up by highly qualified HR professionals with a strategic view of care services provided both in institutions and people’s own homes.  In addition to meeting the specification for a supportive and developing service, the QCS job descriptions also supports underlying human rights principles, and are consistent with the policies and procedures throughout the management system.  Finally, for those who cannot live without task lists, and are prepared to put up with their dangers, task lists can be added to the QCS job descriptions, with at least the safety net that the list is secondary to a more strategic and service development oriented document.


*All information is correct at the time of publishing

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