Decide on a final structure. These design principles came out of his extensive field experience and tend to contribute to effective, trust-enhancing working relationships. Accountability must always be balanced with the appropriate authority. Wherever possible go for a single point of accountability for particular outcomes. Group accountability usually means no accountability.
Accountability works best when it is expressed in a relationship between two individuals.
We are accountable to lots of people for different things, but there should only be one person accountable for an outcome or another person's work. Clinical autonomy for the nature of treatment must be respected and balanced with accountability for work-ing within the utilization standards determined by the hospital board. Managers, e.g., program managers, are accountable for the collective outcomes of their program teams and therefore have particular authorities as managers, i.e., vetoing the appointment of new members, assigning tasks, removing personnel from a role, and conducting performance appraisals and merit reviews. Being held accountable for cooperation and collaboration should carry as much weight as being held accountable for accomplishing tasks within one's area. The table on page 58 is a summary of the group's conclusions concerning the accountabilities and authorities of various roles.