On the Need for an Ethical Understanding of Health Care Accountability

Abstract

In Sweden, like in many other Western countries, public health care is challenged by increasing demands for care and by continuing budget deficits. Person-centered care (PCC) has been introduced as a new strategy to ameliorate the perceived fragmentation in care and is expected to decrease treatment time, reduce the need for return visits, as well as to increase patient satisfaction. However, the changing clinical practices in the PCC approach are assumed to require new accountability practices. This paper is primarily an attempt to characterize a notion of ethical accountability, i.e., a type of accountability that takes into account the human relational responsibility, partial incoherence, and power of reflection. On the grounds of this characterization, the paper aims to provide a basis, among other things, for a discussion of the possibilities of identifying and empirically studying the multimodal expressions in communication that are relevant for this type of accountability. After an initial discussion of the debate on the limits of viewing accountability as transparency, we then turn to our methodological approach and introduce a conceptual analysis of accountability. Next, we discuss some additional features of accountability. Finally, we discuss the possibilities of empirically studying the institutionalization of ethically informed accountability within person-centered health care.