I was reading a white paper, An Accountability Architecture for Success, by Wellesley Partners, comparing military success to health care success: Working together as part of a team, applying their specialized knowledge toward a common goal and Define success based on data-driven, results-based metrics; put someone in charge; and hold people accountable. Does this apply to my health care? I have a team, we periodically set common goals. We try to be data driven, we track certain metrics. But who’s in charge and how do we hold each other accountable? Ideally, I, the patient, am in charge. But in reality its a moving target. When we’re kids our parents are in charge, this shifts as we become tweens, and shifts again when and if our mental acuity deteriorates accidentally or progressively. When does the professional take charge? Do we allow this because that’s the way it is or does it happen because the decisions of the moment seem beyond our abilities or energy level? Is the team clear who makes the decisions? Shared decision-making still means that a decision is made. Can I effectively progress in my health journey when I’m not clear who’s in charge and how we hold ourselves accountable? With my team I make the decisions. If I’m the leader and making decisions, then I must be accountable. I’m accountable to follow the path we set. Upstream, professionals and the offices and institutions they work in are accountable to share data with me and help me interpret the data to set the path. I’m accountable to expect that data, seek other data, and participate in turning the data into information that helps us set common goals. The rest of my team is accountable to help me meet the goals. It feels awkward for me, a knowledgeable, empowered, and energized patient, to talk with my team about decision-making and accountability. We have lots of work to do.
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