Ask healthcare leaders about accountability, and you’ll often get a pause or even a sigh before receiving an answer. Accountability has become synonymous with discipline, hard conversations, and the very real fear of losing a staff member the organization cannot afford to lose. This mindset alone tells us something important. The problem isn’t that healthcare leaders don’t care about holding employees accountability; it’s that we sometimes have a skewed view of what it should look like day-to-day – and what it costs when we avoid it.
When compassion becomes avoidance
Healthcare attracts people who are wired to help, which is one of its greatest strengths. But that same instinct can undermine leadership when compassion becomes a reason to delay or avoid conversations related to performance.
Managers may tell themselves, “My team is going through a lot right now” or “Maybe it will get better on its own.” While understandable, that is emotional rationale rather than leadership judgment. Avoiding accountability doesn’t eliminate discomfort; it simply postpones it. Issues don’t disappear – they resurface later, often larger, more personal, and more disruptive than they needed to be.
Supportive leadership and accountability are not opposites, but rather complementary leadership skills and practices focused on helping individuals and a team be at their best.
The staffing trap
“If I hold them accountable, they might quit.”
It’s one of the most damaging – but understandable – fears in healthcare, especially given chronic staffing shortages. Losing even one nurse, MA, or support staff member can place an immediate strain on patients, providers, and remaining team members. Middle managers also are under constant pressure to reduce turnover.
But this logic misses a critical truth: avoiding accountability doesn’t preserve teams, it redistributes the burden onto your strongest performers.
When underperformance is tolerated, the most reliable employees absorb the extra work. They notice the inconsistency and over time, they disengage or leave. Avoiding accountability doesn’t keep people; it keeps the wrong people.
Time and training: the missing infrastructure
Healthcare routinely promotes high-performing individual contributors into leadership roles without preparing them to lead people. Clinical expertise, operational efficiency, and technical competence are rewarded, while skills like coaching, individual feedback, and performance management are assumed to come “naturally.”
Add relentless operational pressure, and frontline leaders spend their days managing schedules, covering staffing gaps, responding to patient or provider needs, and putting out fires. Accountability conversations require time and skills, both of which are in short supply, resulting in problems that are noticed but not addressed. Conversations are delayed and frustrations build, eroding trust among all team members.
Reframing accountability
When accountability is synonymous with write-ups and consequences, it becomes something leaders dread and employees brace for. But accountability done right isn’t punitive – it’s developmental.
Effective accountability creates structure. It starts with clarity – ensuring expectations are understood, not just stated. It requires honest, timely feedback delivered before a small issue becomes a recurrent pattern. And it depends on follow-through – checking in, recognizing progress, and adjusting support when needed.
Research on high-performing teams shows that frequent, in-the-moment feedback matters. A study published in Harvard Business Review found that a 5:1 ratio of positive to constructive feedback was associated with stronger team performance and connection. Accountability feels punitive only when feedback is rare and imbalanced.
Accountability as a leadership practice
When accountability becomes ongoing coaching instead of a disciplinary event, team performance improves. Leaders spend less time managing resentment and more time developing capability. Star performers feel appreciated and energized rather than demoralized. Simultaneously, underperformers are given a fair opportunity to improve – with clarity and support. Some rise to the standard, while others may opt out. Either outcome is healthier for the team than tolerance of low performance.
The most supportive leaders in healthcare are not the ones who lower standards to avoid discomfort. They are the ones who have the conversations early, respectfully, and consistently. Accountability isn’t about being harsh or mean, it’s about being honest enough to believe your people are capable of more – and caring enough to help them get there.