Book Excerpt: Use these six communication tools to build accountability with your staff

Nurse Leader Insider, April 4, 2019

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The following  is an excerpt from Eileen Lavin Dohmann, MBA, BSN, RN, NEA-BC’s Team-Building Handbook: Accountability Strategies for Nurses.

The words we use can either dampen accountability or trigger accountability. The next time you encounter a situation where you want to build accountability, try using language that produces

These six communication tools can be used to build accountability—in yourself and your peer group:

  1. Framing: Set the tone and context for the commitment.
  2. Effective questions: Turn on the creative power of the participants
  3. Active listening: Make sure people are being heard and understood
  4. Requests and offers: Generate commitments
  5. Hear yes/no: Verify accountability
  6. Acknowledgment: Celebrate behavior that works

These words create the necessary conditions for accountability. Each one creates a positive dynamic that makes it easy for accountability to happen. Let’s look at how each is used.


Framing is when you ask the person you’re speaking with, or the people in your meeting, to listen and process how to “be” in the meeting. Framing tells participants how to focus their attention and efforts in the discussion or meeting. It creates the listening environment in which you can encourage accountability. It creates one common mindset and allows everyone to do meaningful work.

How It Works

Consider this: If six people are in the room, you have six mindsets and six kinds of listening. Remember, most people will be on autopilot. They’ll be operating from habit. Let’s look at what that
means. It’s possible that in the room the following people will hear what you’re saying about an initiative to reduce the number of falls on the unit, but be thinking this:

  • Person A: Hope my husband remembers to pick up my son for soccer practice. (Clearly, not listening at all!)
  • Person B: What critical assessment can I make of what is being said in order to look smart?
  • Person C: What can I do to not be noticed, to avoid getting an assignment?
  • Person D: That’s interesting. It reminds me of the time... (You had this person, but just for a second.)
  • Person E: I hope this won’t take too long. I have to finish a paper for school. (Not engaged.)

You can see that doesn’t bode well for a productive meeting. And this is natural; no one is being intentionally uncooperative.

Using accountability language
It’s easy to fix the random mindset in the room by asking people to be a certain way, to do a specific kind of work, and to be open to the possibility of accountability. This is what framing sounds like:

  • I ask that all of us be in focusing on how we can decrease falls on our unit.
  • I’d like to set the goal to decrease preventable patient falls on our unit by 25% in the next three months.
  • We’ll be listening to a webinar now from a hospital who decreased their preventable falls by 50% in nine months.
  • Please listen to the tactics that they used and be prepared to make commitments for our unit at the end. Thank you.

Everyone wants to do the right work and to contribute. All we have to do is ask!

This is an excerpt from Team-Building Handbook: Accountability Strategies for Nurses.

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