Accountability and reliable promises, pt. 2

Part 2 in a 3-part series

What does it mean to have accountability? As we observed in an earlier post, piggybacking off of Mark Graban, if a hospital manager expect nurses to be responsible for filling foam canisters to increase the odds of hand washing to protect patients, there needs to be an explicit promise between that manager and the nurses. Such a promise requires both a clear request (or offer) and an acceptance. Promise = Request + Acceptance.

Now, what can we say about the components of an effective request or offer? Let’s make explicit what was partly implicit in the above example. An effective request or offer consists of the following:

Master difficult conversations

Learn my best tips for staying cool under pressure and elevating your leadership in complex times.


  • Clear conditions for satisfaction. There needs to be a shared understanding of what it means to restock a canister.
  • Clear timeframe or deadline. What days and what times of day will the nurse restock the canister—or at least check to see if it needs restocking?
  • A specific speaker. What do we mean by this? If a vague pronouncement comes out from “management” about who is responsible for restocking the canisters, there is not a specific speaker. The nurse doesn’t have anybody to respond to (by accepting, declining, counter-offering, or promising to promise). Another way that a speaker can be “missing” is if a manager holds uncommunicated expectations; they want the nurses to refill the canisters, and maybe even mention it in passing, but never actually make a request.
  • A specific listener. On the other hand, let’s say a particular manager makes the request but communicates it vaguely to a full team of nurses. Now, we have a specific speaker but not a specific listener.
  • A shared “background of obviousness.” This is a fancy way of saying that when the manager says “restock the canisters in the middle hallway”, both the manager and the nurse understand which canisters these are and which hallway is the middle hallway.

If any one of these elements is missing, the odds of things breaking down increases. So it makes sense to apply more attention and rigor to this simple everyday act of making a request than we normally do.

But is making a series of unique requests to different nurses going to produce a quality process? In his post, Mark Graban suggests that a sound process also requires standardized work. This is a term from Lean management. It means that a particular group of people (e.g a team, a department, an organization, a profession) agrees to follow a common process, one that is the best current method for that process. Often, the members of the team who manage the process are in the best position to decide what is the best current method—and then update it as they find ways to improve it.

In the language of promises, standardized work means that there is a promise among the members of a group, and likely between them and their manager, about what conditions for satisfaction to produce and how to produce them. In this example: what constitutes a filled canister and what is the best sequence of actions (and pace of refilling and inventory of foam) to complete this process.

Here’s the thing: just having a list of the sequence of actions, even the most beautiful visual checklist, doesn’t guarantee that people will follow it. Why? Because, as we’ve seen, a promise requires an effective request (or offer) and a clear acceptance. For example:

  • Let’s say five nurses in a ten-nurse unit come up with the best current method for refilling the canisters, share it with the other five nurses, and say “Here’s the new process. Let’s make it happen.” Period. What is missing? A request! These five nurses have made a declaration but haven’t actually asked their colleagues to agree to do it.
  • Now, let’s say the same five nurses propose a best current method and ask their colleagues if they’re willing to follow it. The colleagues nod their heads or remain silent. Great, we’ve got a promise, right? Nope. Unless a nurse explicitly accepts the request, there is no promise between that nurse and the rest of the team. And what if four of the other five nurses explicitly accept the request and the fifth nods vaguely? Now you have nine of the ten nurses committed to standardized work. It’s better than nothing, but it won’t meet most organizations definition of standardized work unless everybody is doing it. And for everybody to do it, everybody needs to make a promise.

To summarize: whether in “traditional” management or in Lean management, accountability requires effective promises, which in turn, require effective requests and acceptance of those requests.

But is that all? Not in the least. In the third and final post in this series, we’ll examine how to transform an effective request onto a reliable promise. And in future posts beyond that, we’ll look at the breakdowns that can occur even after you have a reliable promise—specifically, during the phase of delivering that promise and the phase of assessing the results.