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Accountability
Accountability refers to the implicit or explicit expectation that one may be called on to justify one's beliefs, feelings, and actions to others. Although most theories of decision making have conveniently assumed that decision makers act as isolated individuals, decision makers, including those in the field of medicine, seldom think and act free from social influences.
Decision making in the field of medicine is fraught with complex, conflicting pressures from various parties, including patients, physicians, hospitals, health policy makers, and insurers, that promote distinct and often competing objectives, such as maximizing life expectancy versus optimizing quality of life, or weighing quality of treatment against economic constraints. Therefore, to best structure accountability relationships and ultimately to improve the quality of decisions in the medical setting, careful analysis of accountability is warranted.
This entry reviews findings from empirical research that addresses the impact of many types of accountability on decision making and attempts to identify the conditions under which accountability will improve decision making.
Many Kinds of Accountability
It is intuitive to think that accountability will breed hard thinking and that thinking harder will translate to thinking better. But according to reviews of the accountability literature, accountability promotes self-critical and effortful thinking only under certain conditions.
Different types of accountability can be distinguished based on the specific nature of justification an individual is expected to provide for his or her decisions: To whom is he or she accountable, for what, and according to what ground rules must he or she justify his or her decisions? For example, a decision maker may be accountable to an audience with known versus unknown views, to authority figures whom the decision maker may perceive as legitimate or illegitimate, and for either the outcome or the process of the decision.
Based on their review of the accountability literature, Jennifer Lerner and Phillip Tetlock reported that decision makers engage in more careful thinking only when they learn prior to forming any opinions about the decision that they will be accountable to an audience (a) whose views are unknown, (b) who is interested in accuracy, (c) who is more interested in processes rather than outcomes, (d) who is reasonably well informed, and (e) who has a legitimate reason for probing the reasons behind decisions. Therefore, simply leading decision makers to expect to justify their decisions to others is insufficient to promote thorough decision making. Instead, organizations and authorities must methodically tailor accountability structures to promote more careful thought processes.
Will Accountability Improve Decision Making?
Although making a decision maker accountable to an unknown audience before the decision is made promotes more careful thought processes, employing this specific kind of accountability by no means ensures improved decision making. Rather, the effects of accountability depend on the types of decisions and the cognitive processes involved, resulting in some improved decisions, some unchanged decisions, and some degraded decisions.
When Accountability Improves Decision Making
Predecisional accountability to an unknown audience improves decision making to the extent that suboptimal decisions would—under default conditions—result from lack of effort and self-critical attention to the decision process. In other words, as long as improvements in decision making require only greater attention to the information provided, and not acquisition of special skills or training in formal decision rules, the concentrated thinking motivated by accountability pressure will result in thinking better. For example, research has shown that accountable decision makers with a heightened awareness of decision processes made better decisions, specifically, by reducing the tendency for happiness from an unrelated event to elicit heuristic, stereotypic judgments; by reducing blind commitment to a prior course of action in an effort to recoup sunk costs; and by decreasing the likelihood of mindlessly rating a conjunctive event (e.g., shy librarian) as more likely than a simple event (e.g., librarian).
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- Basis for Making the Decision
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- Uncertainty in Medical Decisions
- Unreliability of Memory
- Value Functions in Domains of Gains and Losses
- Worldviews
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