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The importance of accountability: between people’s actions, giving care attention, and the context in which we work.

I am a great fan of the “Undercover Economist” series of articles by Tim Harford, that appears in the Saturday Financial Times. This week Tim asked, “Why would people so poor that their weekly wage would not even cover the cost of the newspaper put their children into private school, when there is a free public school?”.

Also why would poor people in poor and developing countries with free healthcare choose to pay to go to private doctors that are in these countries less qualified than their public sector free ones.

It seems bizarre.

The answer according to studies by Das and Hammer that Tim Harford quotes, is that these doctors give their patients much more time and attention. In other work by James Tooley, the teachers pay more attention to their pupils. In contrast some public sector teachers were asleep in the classroom when a film crew arrived, even though they knew the film crew were coming.

The answer they say, is accountability. If you are paid directly by your patients or pupils’ parents, even though the amount is really small, you have to demonstrate care and attention, otherwise they will not come back or use your service.

In contrast, the disconnection between the source of the income and the people they serve in these free public sector leads to a lack of accountability. The conclusion from the article is that a little accountability goes a long way. It also concludes that low-cost private sector services should be nurtured.

If we consider how this maps across to the UK public sector we get an interesting contrast. The accountability to the UK government departments is often about penalties for failing to reach targets, rather than accountability to the people being served. This is being redressed through surveys from the populations of users, but this is not accountability, but feedback. The accountability is still through a third party (or third parties) rather than to the “customers”.  The importance of accountability is being lost.

If we look at private sector responsibilities, there is or course an accountability to management and the owners (shareholders) but that is only served if the public themselves are served as well and continue to come back and use the services.

So, think about the links you can make between people’s actions and their accountability to the people they serve: The public, the customers and even other parts of the organisation, for back office functions.

Contrast the thinking of “Service level agreements” vs “service” and “accountability”. SLAs may encapsulate part of the issue but certainly not all of it. Do they undermine the importance of accountability in caring for people and paying attention?

And think through the thoughts of the private sector doctor in these poor nations who are taking the time to listen to their patients, understanding their needs and helping them as much as they can. In contrast a UK NHS Hospital Consultant I spoke with was extremely frustrated to be told that he had only 5 or 7.5 minutes in which to conduct an appointment.

Where is the accountability in that?

Where is the accountability in your services?

Phil Jones