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For QI programmes, managers should keep in mind its consistency with the hospital's mission and provide commitment, resources, education and role accountability.
This limited role clarity amongst all and absence of role accountability in ASHAs led to her greater non-compliance and poor performance.
44 Factors to motivate/engage middle and senior management in QI included senior management commitment, provision of resources and managerial role accountability.
Role confusion within teams, and between teams, was a recurring theme and is consistent with the findings of Cook et al. [ 37] who postulate that the intra- and multidisciplinary care inherent in hospital patient management, results in unclear role accountability.
This sits neatly within the role performance framework for OT nurses developed by McGarvey et al [ 43] in which the key dimensions of OT nurse work were context (e.g. atmosphere, technology, physical aspects etc), role performance (e.g. socialisation into the role, accountability etc) and personal and professional characteristics of nurses.
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Effective schools have clear leadership roles, accountability and systems for ensuring that all teaching is at least good, has impact and is focused on learners' needs.
Civil society plays a vital role in accountability, as a watchdog, helping people to hold their governments to account, which can underpin better governance and is another way to help hold on to development wins".
In all of this I blame, first and foremost, the American public for ceding the role of accountability to media, corporations, government and political organizations.
While different departments and reporting lines provide clarity of role and accountability, they also create artificial barriers that block progress.
Fifth, the SDGs need to ensure a more prominent role for accountability while also promoting country ownership.
Overall, these processes could improve performance of CHAs by triggering the 'anticipation of being valued by the community, a perception of improvement in social status, and having a valuable social role and accountability to the beneficiaries' [ 37].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com