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PubMed2002

Effects of procedure and outcome accountability on interview validity.

This study tested effects of holding interviewers accountable for either the procedure they follow to make interview judgments (procedure accountability) or the accuracy of their judgments (outcome accountability) on interview validity. Undergraduates (N = 338) simulated employment interviewers in an experiment that crossed 2 levels of procedure accountability with 2 levels of outcome accountability. They watched videotapes of 60 managers answering an interview question and rated the managers on leadership potential. The dependent variable was the correlation between their interview judgments and supervisory ratings of the managers' actual leadership performance on the job. Results showed that procedure accountability increased interview validity and outcome accountability lowered it. Participants' apparent attentiveness fully mediated effects of procedure accountability on interview validity.

Adolescent↗
PubMed2004

Accountability and health systems: toward conceptual clarity and policy relevance.

Improved accountability is often called for as an element in improving health system performance. At first glance, the notion of better accountability seems straightforward, but it contains a high degree of complexity. If accountability is to be more than an empty buzzword, conceptual and analytical clarity is required. This article elaborates a definition of accountability in terms of answerability and sanctions, and distinguishes three types of accountability: financial, performance and political/democratic. An analytic framework for mapping accountability is proposed that identifies linkages among health sector actors and assesses capacity to demand and supply information and exercise oversight and sanctions. The article describes three accountability purposes: reducing abuse, assuring compliance with procedures and standards, and improving performance/learning. Using an accountability lens can: (1) help to generate a system-wide perspective on health sector reform, (2) identify connections among individual improvement interventions, and (3) reveal gaps requiring policy attention. These results can enhance system performance, improve service delivery and contribute to sound policymaking.

Delivery of Health Care↗
PubMed1984

Unit days in accounts receivable: a management tool.

The importance and usefulness of the statistic "Days in accounts receivable" are well known among patient accounts managers. The same principles that apply to that well-known statistic may also be effectively applied to a single unit within any patient accounting department. With the calculation of a unit days in accounts receivable, the same evaluation and measurements of efficiency may be applied to individual files and patient accounts representatives. The results allow individual employees participation in the same measurable goals and objectives as are applied to the overall operation of the department, as well as supplying the patient accounts manager an additional valuable tool in analyzing total accounts receivable.

Accounting↗
PubMed1991

Hospital accounting and information systems: a critical assessment.

Public sector organisations seem to be caught up in the global wave of 'neo-Thatcherism'. As such, they are being held 'accountable' today by their respective government finance departments for the costs and benefits of the services they provide to the general public. As the public purse tightens, hospitals (and related health service units) more and more compete with other public sector organisations (old-age pensions and services, post-secondary education, day-care centres, port authorities, unemployment insurance, parks and recreation, elite sport programs, aboriginal peoples aid and development, and so on) for a diminishing piece of what seems a smaller and smaller pie. In this 'fight-for-funding', hospitals seem particularly vulnerable. Sky-rocketing costs, public resentment of doctors' high income and a deliberate restriction and limiting of medical school places, among other things, contribute to general public antagonism. The message for hospitals is that cost-effective accountability will loom large when hospitals come begging at the public trough. Even left-wing politicians today seem to be heeding the words of free-market economists like Freedman of Chicago. 'Privatisation' is the constant threat for those deemed inefficient. As a consequence, hospital administrators around the world, caught up in this trend, seem to be stampeding to 'boot-up' some kind of new accounting information system. For example, at my own university hospital (Queen's University, Kingston, Canada), the hospital administrators are in the process of introducing a version of the Johns Hopkins Hospital (Baltimore, Maryland) case-mix-loading cost-accumulation system. In other parts of the world they are known by other fancy names such as 'patient-costing', 'diagnosis-related-groups' (or DRGs). Trendy accounting systems seem to be the order of the day, a sort of panacea for the current plague of problems hospitals face. As the new systems become operational, however, traditional management accounting issues will likely surface. Particular departments, wards and surgeons will be fingered by the system for excessive costs, inefficiency, and under-utilisation of equipment. When this happens, the medical professionals will begin to pay attention to these systems. They will discover that the accounting decisions (which cast them in an unfavourable light) are subjective, arbitrary, and problematic. The old debates, such as incremental versus full-costing, transfer pricing and cost of capital, will be played out again; but now on the turf of hospitals. As the debates drag on, it seems likely that in the interim the new accounting systems could do more harm than help. The rest of the paper attempts to explain why.

Accounting↗
PubMed1994

Custom accounts receivable modeling.

In hospital and clinic management, accounts are valued as units and handled equally--a $20 account receives the same minimum number of statements as a $20,000 account. Quite often, the sheer number of accounts a hospital or clinic has to handle forces executives to manage accounts by default and failure--accounts mature on an aging track and, if left unpaid by patients, eventually are sent to collections personnel. Of the bad-debt accounts placed with collections agencies, many are misclassified as charity or hardship cases, while others could be collected by hospital or clinic staff with a limited amount of additional effort.

Accounts Payable and Receivable↗
PubMed2000

Movement toward individual health benefit accounts.

There are strong pressures for employers to pursue defined contribution health benefits with individual health benefit accounts such as Medical Savings Accounts (MSAs), Health Care Reimbursement Accounts (HCRAs), and Comprehensive Individual Medical Accounts (CIMAs). Health care consumers are becoming more assertive. The political backlash against managed care is eroding provider-based cost control mechanisms. Health insurance premium inflation is intensifying. Advocates of the movement toward individual health benefit accounts view them as a means of restoring autonomy to the physician-patient relationship and controlling costs. Opponents are concerned that individual health benefit accounts of any type will segment insurance markets, benefiting the healthy and wealthy at the expense of the chronically ill and the poor. Can these accounts be designed so as to achieve their positive effects and minimize negative effects?

Community Participation↗
PubMed1999

Accounting units in DNA.

Chargaff's first parity rule (%A=%T and %G=%C) is explained by the Watson-Crick model for duplex DNA in which complementary base pairs form individual accounting units. Chargaff's second parity rule is that the first rule also applies to single strands of DNA. The limits of accounting units in single strands were examined by moving windows of various sizes along sequences and counting the relative proportions of A and T (the W bases), and of C and G (the S bases). Shuffled sequences account, on average, over shorter regions than the corresponding natural sequence. For an E. coli segment, S base accounting is, on average, contained within a region of 10 kb, whereas W base accounting requires regions in excess of 100 kb. Accounting requires the entire genome (190 kb) in the case of Vaccinia virus, which has an overall "Chargaff difference" of only 0.086% (i.e. only one in 1162 bases does not have a potential pairing partner in the same strand). Among the chromosomes of Saccharomyces cerevisiae, the total Chargaff differences for the W bases and for the S bases are usually correlated. In general, Chargaff differences for a natural sequence and its shuffled counterpart diverge maximally when 1 kb sequence windows are employed. This should be the optimum window size for examining correlations between Chargaff differences and sequence features which have arisen through natural selection. We propose that Chargaff's second parity rule reflects the evolution of genome-wide stem-loop potential as part of short- and long-range accounting processes which work together to sustain the integrity of various levels of information in DNA.

Base Composition↗
PubMed2004

Patient accounts for noncompliance with diabetes self-care regimens and physician compliance-gaining response.

The purpose of this study was to identify diabetics' accounts for medical noncompliance, physicians' compliance-gaining strategies elicited in response to those accounts, and to examine the relationship between accounts and compliance-gaining strategies. Telephone surveys of diabetics from Kentucky and Tennessee assessed patient perceptions of physician-patient communication during their last diabetes treatment-related appointment. Eighty-four patients were able to provide categorical data for analysis. Patient account strategies for noncompliance were coded as concessions, excuses, justifications, and refusals. Physician compliance-gaining strategies were coded as positive-regard, negative-regard, or neutral-regard strategies. Results showed the most common patient account was concession (33%), then excuse (23%), justification (22%), and refusal (7%). The most common physician compliance-gaining strategy was neutral regard (54%), then positive regard (31%) and negative regard (15%). Results also indicated that patient account and physician compliance-gaining strategy were related. Specifically, concession accounts from patients elicited a subsequent neutral-regard compliance-gaining strategies from the physician in 76% of concession cases. Results also show that justifications were most likely to elicit neutral- (52%) or positive-regard (43%) strategies. Implications for physician practice and future research are discussed.

Adolescent↗
PubMed2002

Accounting for unprotected sex: stories of agency and acceptability.

Based on the idea that risks are knowable, calculable and preventable, dominant social scientific and health promotion discourses foster an image of individual risk control and responsibility. The presentation of the self is a moral enterprise. Accounts of unprotected sex by HIV positive people who have the potential to transmit HIV to their sexual partners can be particularly morally charged. Drawing on 73 depth qualitative interviews with HIV positive people and their sexual partners, this paper explores how the interview accounts of unprotected sex can illuminate the way in which the self is presented within the context of situated norms of risk acceptability and moral responsibility. We identify two forms of account: stories of agency; and stories of acceptability. Stories of agency tend to deny agency and abdicate individual responsibility given the circumstances, and were also a key feature of accounts in which the sexual partners of HIV positive people were placed at risk of HIV transmission. Categories of appeal included the denial of agency as a consequence of: risk calculus and condom accidents; alcohol and drug effects; powerlessness and coercion; and forces of nature. By contrast, stories of acceptability tend to justify unprotected sex as acceptable. Categories of appeal included: HIV positive concordance; and commitment in relationships. Other forms of justification included: alter responsibility; and intentional HIV transmission. We conclude that accounts of risk management are risk managed. We call for greater attention by social scientists to the way in which accounts are constructed, and in particular, to 'anti-rational' forms of explanation within accounts.

Anecdotes as Topic↗
PubMed2003

Using accountability to improve reproductive health care.

Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, however, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems.

Attitude of Health Personnel↗
PubMed1987

Accountability and judgment processes in a personality prediction task.

In this experiment, we investigated the impact of accountability--social pressures to justify one's views to others--on cognitive processing in a personality-prediction task. Subjects were presented with the responses of actual test-takers to 16 items from Jackson's Personality Research Form (PRF) and asked to predict how these individuals responded to an additional set of 16 items from the same test. Subjects were assigned to a no-accountability condition (they learned that all of their responses would be anonymous), a preexposure-accountability condition (they learned of the need to justify their responses before seeing the test-takers' PRF responses), and a postexposure-accountability condition (they learned of the need to justify their responses after seeing the test-takers' PRF responses). Preexposure-accountability subjects reported more integratively complex impressions of test-takers, made more accurate behavioral predictions, and reported more appropriate levels of confidence in their predictions than did either no-accountability or postexposure-accountability subjects. We conclude by considering possible psychological mediators of these effects as well as the broader theoretical implications of the findings for the development of contingency models of judgment and choice.

Humans↗
PubMed1996

Would reading an account of an event refresh your memory?

Witnesses to an event who have prepared an account of it may be given an opportunity to review this account or to read another account before testifying. The authors investigated the effects of this procedure by using participant accounts and both accurate and misleading experimenter-prepared accounts. Another experimental group did not review any account. Participants given no opportunity to refresh memory were less accurate in free recall than participants who refreshed memory, but they were equally accurate in answering direct questions. Measures of consistency between performance on testing sessions showed that the opportunity to review a self-produced account resulted in more consistent performance than nonreview. Results of this study have important implications in pretrial witness preparation.

Adolescent↗
PubMedDate not supplied

The challenge of accountability in nursing.

The authors examine the literature on accountability in nursing and analyze the following questions: What is meant by accountability in nursing? To whom are nurses accountable? For what should nurses be held accountable? Finally, the implications of accountability for the nursing profession are explored. In order for nursing to grow and develop as a profession based on sound theoretical foundations, nurses need to examine what it means to be truly accountable. The authors point out that accountability is a complex issue that requires nurses to examine their practice relative to the needs of healthcare consumers, their relationships with other healthcare professional, and the increasingly critical role of nursing in the healthcare system.

Education, Nursing↗
PubMed2000

401(k) plan asset allocation, account balances, and loan activity in 1998.

The Employee Benefit Research Institute (EBRI) and the Investment Company Institute (ICI) have been collaborating for the past three years to collect data on participants in 401(k) plans. This effort, known as the EBRI/ICI Participant-Directed Retirement Plan Data Collection Project, has obtained data for 401(k) plan participants from certain of EBRI and ICI members serving as plan record keepers and administrators. The report includes 1998 information on 7.9 million active participants in 30,102 plans holding nearly $372 billion in assets. The data include demographic information, annual contributions, plan balances, asset allocation, and loans, and are broadly representative of the universe of 401(k) plans. The database also includes three years of longitudinal information on approximately 3.3 million participants. Key findings include: For all 401(k) participants in the 1998 EBRI/ICI database, almost three-quarters of plan balances are invested directly or indirectly in equity securities. Specifically, 49.8 percent of total plan balances are invested in equity funds, 17.7 percent in company stock, 11.4 percent in guaranteed investment contracts (GICs), 8.4 percent in balanced funds, 6.1 percent in bond funds, 4.7 percent in money funds, and 0.3 percent in other stable value funds. Participant asset allocation varies considerably with age. Younger participants tend to favor equity funds, while older participants are more disposed to invest in GICs and bond funds. On average, participants in their 20s have 62.1 percent of their account balances invested in equity funds, in contrast to 39.8 percent for those in their 60s. Participants in their 20s invest 4.7 percent of their assets in GICs, while those in their 60s invest 20.6 percent. Bond funds, which represent 4.7 percent of the assets of participants in their 20s, amount to 9.0 percent of the assets of participants in their 60s. Investment options offered by 401(k) plans appear to influence asset allocation. For example, the addition of company stock substantially reduces the allocation to equity funds and the addition of GICs lowers allocations to bond and money funds. The average account balance (net of plan loans) for all participants was $47,004 at year-end 1998, which is 26 percent higher than the average account balance at year-end 1996. The median account balance was $13,038 at year-end 1998. The balances, however, represent only amounts with current employers and do not include amounts remaining in the plans of prior employers. The average balances of older workers with long tenure indicate that a mature 401(k) plan program will produce substantial account balances. For example, individuals in their 60s with at least 30 years of tenure have average account balances in excess of $185,000. The ratio of account balance to 1998 salary varies with salary, increasing slightly as earnings rise from $20,001 to $80,000, and falling a bit for salaries greater than $80,000. The increase in ratio likely reflects a greater propensity of higher-income participants to save, whereas the decline after $80,000 results from contribution and nondiscrimination rule constraints.

Adult↗
PubMed2003

Health systems' accountability for patient safety.

Patient safety experts, including the Institute of Medicine Committee on Quality of Health Care in America, have emphasized the need to focus on systems failure as the source of most error in health care. This requires an emphasis on prevention and on health systems' accountability for error. This article discusses traditional and evolving approaches to systems' accountability for error. While there are some significant recent developments, such as the JCAHO new Patient Safety Goals, many issues remain about how to determine and enforce systems' accountability for error. These include identifying what systems will be held accountable for and how accountability will be enforced. While reporting of errors is one route toward accountability, many questions remain regarding the most effective approach toward error reporting. Research on and evaluation of reporting systems and other approaches toward systems' accountability will be important in moving forward in this area.

Accreditation↗
PubMed1993

Mental accounting and the process of multiattribute choice.

Tversky and Kahneman (1981) discussed how multiattribute choices may be framed in terms of alternative psychological accounts established for specific problems. They identified three levels of account: minimal, topical and comprehensive. The role of these mental accounts is investigated in two studies of Tversky and Kahneman's Jacket and Calculator problem. In the first, systematic variation of jacket and calculator prices showed that the latter had a large effect on choice, and the former a small but significant effect. It is concluded that: (1) the effect of the calculator price supports Tversky and Kahneman's view that people frame simple choices in terms of specific, topical accounts; and (2) the jacket price effect supports the view that more comprehensive mental accounts also influence evaluation and choice. In the second study, think aloud evidence is presented which supports these conclusions and indicates that the level of account adopted may be contingent on characteristics of the choice problem.

Accounting↗
PubMed1999

Use of a cost accounting system to evaluate costs of a VA special program.

BACKGROUND: The Department of Veterans Affairs (VA) established six mobile clinics to provide care for rural veterans. Each was operated by a parent VA Medical Center (VAMC). OBJECTIVE: To describe the use of a cost-accounting system which does not provide costs at the service or patient level to determine the costs of the mobile clinics. RESEARCH DESIGN: Costs per visit were compared among the mobile clinics with the parent VAMCs and with simulated fixed-location clinics. Cost data came from VA's Centralized Accounting for Local Management (CALM) data. Utilization data came from VA's outpatient file. RESULTS: Information was obtained from the VAMCs' fiscal services to reallocate costs among the CALM subaccounts to generate cost data that was comparable among the mobile clinics. Costs per visit for the mobile clinics were twice as high as those of the parent VAMCs. Costs per visit would be lower at fixed-location clinics unless the volume were substantially less than that provided by the mobile clinics. CONCLUSION: Differences between cost allocations for accounting purposes and research are likely to necessitate adjusting cost accounting data for research purposes. Fortunately, information from the accountants or primary data can lead to a cost database which is appropriate for research evaluations. In the mobile clinics study, the analysis of cost accounting data led to the conclusion that mobile clinics were not a cost-effective way in which to provide care to rural veterans.

Accounting↗
PubMed2005

The utilization of activity-based cost accounting in hospitals.

Healthcare costs are being examined on all fronts. Healthcare accounts for 11% of the gross national product and will continue to rise as the "babyboomers" reach retirement age. While ascertaining costs is important, most research shows that costing methods have not been implemented in hospitals. This study is concerned with the use of costing methods; particularly activity-based cost accounting. A mail survey of CFOs was undertaken to determine the type of cost accounting method they use. In addition, they were asked whether they were aware of activity-based cost accounting and whether they had implemented it or were planning to implement it. Only 71.8% were aware of it and only 4.7% had implemented it. In addition, only 52% of all hospitals report using any cost accounting systems. Education needs to ensure that all healthcare executives are cognizant of activity-based accounting and its importance in determining costs. Only by determining costs can hospitals strive to contain them.

Accounting↗