In health care, accountability is being championed as a promising approach to meeting the dual imperatives of improving care quality while managing constrained budgets.
Few studies focus on public sector organizations’ responsiveness to government imperatives for accountability. This study applied and adapted a theory of organizational responsiveness to community care agencies operating in Ontario, Canada, asking the question: What is the array of realized organizational responses to government-imposed accountability requirements among community agencies that receive public funds to provide home and community care?
Using a sequential complementary mixed methods approach, the authors gathered data through a survey of 114 home and community care organizations in Ontario and interviews with 20 key informants representing 13 home and community care agencies and four government agencies. Findings were generated using a parallel mixed analysis technique.
In addition to responses predicted by the theory, the study found that organizations engage in active, as well as passive, forms of compliance; this response is referred to as internal modification in which internal policies, practices, and/or procedures are changed to meet accountability requirements. The study also found that environmental factors, such as the presence of an association representing organizational interests, can influence bargaining tactics.
This study helps illuminate the range of likely responses to accountability requirements and is a first step toward encouraging the development of accountability frameworks that favor positive outcomes for organizations and those holding them to account.
Tailoring agreements to organizational environments, aligning perceived compliance with behaviors that encourage improved performance, and allowing for flexibility in accountability arrangements are suggested strategies to support beneficial outcomes.