Changes in the healthcare environment have led to the expectation that healthcare professionals be accountable for their practice. Accountability, as a concept, has been defined as responsibility and answerability for one's actions. Numerous authors have described varying levels of accountability within different care delivery models; however, to date, the specific relationship between multiple care delivery models and accountability has not been studied.
Employing Donabedian's conceptualization of structure, process, and outcome as a theoretical framework, this study used a comparative survey design to describe and compare relationships between perceived nurse accountability and three different nursing care delivery models--team nursing, primary nursing and patient-focused care. Data were collected from surveys administered to staff nurses in twenty-one medical and/or surgical patient care units at five acute care hospital sites in New England. The hospitals selected represented two groups: (a) three hospitals where nurses consistently practiced according to a single care delivery model across all medical and/or surgical units and (b) two hospitals where nurses practiced according to varying care delivery models. Data for each nursing care delivery model were collected from at least two sites.
The dependent variable, nurse accountability, was measured, on individual and group levels, using the Specht and Ramler Accountability Index. The independent variable, nursing care delivery model, was measured with a researcher-designed nursing care delivery checklist. Nurse demographic data were also collected.
Overall group and individual accountability scores were presented. Mean group accountability scores were significantly lower than mean individual accountability scores. Significant relationships were detected between group accountability scores and years in current position, and between individual accountability scores and hours worked per week. A weak relationship between group accountability scores and nursing care delivery model was detected with registered nurses who practice in a team nursing care delivery model demonstrating lower group accountability scores than registered nurses who practiced in primary and patient-focused care environments. Both group accountability and individual accountability scores for each nursing care delivery model remained relatively unchanged when controlling for each of the significant demographic variables. Implications for nursing administration, education, practice and research were presented.
