HCA 822 Topic 2 DQ 1: Shared Accountability
Why is it so difficult is a diagnostic question. Health care makes shared accountability hard for structural reasons that would defeat committed people, and naming them is the answer.
Editorial process
Last reviewed · August 16, 2026
Why is it difficult — a diagnosis, not a lament
The question assumes the goal is worth having and asks why it fails anyway, which means the answer must not be that people are insufficiently committed. Look for obstacles that would defeat committed people, and health care supplies several. Professional socialisation is the first: medicine, nursing, pharmacy and allied health are trained separately, licensed separately and hold different accountabilities for the same patient, so shared purpose has to be built across boundaries that the training system spent years constructing. Employment structure is the second, and it is frequently decisive: physicians may be independent contractors with admitting privileges rather than employees, so the organisation's mission and the clinician's economic interest are not automatically aligned and no amount of internal communication makes them so. It is worth saying so explicitly at the start, because a post that opens by blaming attitudes has already answered a weaker question than the one asked.
Then the incentive and measurement layer, which is where good intentions run out. Accountability requires attribution, and health care outcomes are produced by teams across time, so attributing a readmission or a complication to any one contributor is genuinely difficult. Shared accountability without shared measurement becomes a slogan, and shared accountability with badly designed measurement becomes something worse — people accountable for outcomes they cannot influence, which reliably produces gaming or withdrawal. Add the pace of turnover, which resets relationships faster than trust accumulates, and the diffusion of responsibility that any shared arrangement invites. The prompt requires research support, so plan for it: cite implementation and interprofessional collaboration studies rather than management commentary, and let one of your obstacles be the one your evidence is strongest on so the post has a spine. Say which obstacle you consider decisive, since a list of four treated equally reads as a survey rather than a diagnosis.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Diagnose an organisational difficulty structurally rather than motivationally.
- 02Explain how professional training boundaries persist into practice.
- 03Connect accountability to attribution and measurement.
- 04Support an organisational argument with empirical literature.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
Important information for writing discussion questions and participation Hi Class, Please read through the following information on writing a Discussion question response and participation posts. Contact me if you have any questions. Important information on Writing a Discussion Question Your response needs to be a minimum of 150 words (not including your list of references) There needs to be at least TWO references with ONE being a peer reviewed professional journal article. Include in-text citations in your response Do not include quotes—instead summarize and paraphrase the information Follow APA-7th edition Points will be deducted if the above is not followed Participation –replies to your classmates or instructor A minimum of 6 responses per week, on at least 3 days of the week. Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article Each response needs to be at least 75 words in length (does not include your list of references) Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count. Follow APA 7th edition Points will be deducted if the above is not followed Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points. Here are some helpful links Student paper example Citing Sources The Writing Center is a great resource Welcome to class Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to. I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you. Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted. If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations. Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements. Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week. HCA 822 Topic 2 DQ 1 I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course! Name: Discussion Rubric Grid View List View Excellent 90–100 Good 80–89 Fair 70–79 Poor 0–69 Main Posting: Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. 40 (40%) – 44 (44%) Thoroughly responds to the Discussion question(s). Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. 35 (35%) – 39 (39%) Responds to most of the Discussion question(s). Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. 31 (31%) – 34 (34%) Responds to some of the Discussion question(s). One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. 0 (0%) – 30 (30%) Does not respond to the Discussion question(s). Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. Main Posting: Writing 6 (6%) – 6 (6%) Written clearly and concisely. Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. 5 (5%) – 5 (5%) Written concisely. May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. 4 (4%) – 4 (4%) Written somewhat concisely. May contain more than two spelling or grammatical errors. Contains some APA formatting errors. 0 (0%) – 3 (3%) Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Main Posting: Timely and full participation 9 (9%) – 10 (10%) Meets requirements for timely, full, and active participation. Posts main Discussion by due date. 8 (8%) – 8 (8%) Meets requirements for full participation. Posts main Discussion by due date. 7 (7%) – 7 (7%) Posts main Discussion by due date. 0 (0%) – 6 (6%) Does not meet requirements for full participation. Does not post main Discussion by due date. First Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. First Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. First Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Second Response: Post to colleague’s main post that is reflective and justified with credible sources. 9 (9%) – 9 (9%) Response exhibits critical thinking and application to practice settings. Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. 8 (8%) – 8 (8%) Response has some depth and may exhibit critical thinking or application to practice setting. 7 (7%) – 7 (7%) Response is on topic and may have some depth. 0 (0%) – 6 (6%) Response may not be on topic and lacks depth. Second Response: Writing 6 (6%) – 6 (6%) Communication is professional and respectful to colleagues. Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 5 (5%) – 5 (5%) Communication is mostly professional and respectful to colleagues. Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. 4 (4%) – 4 (4%) Response posed in the Discussion may lack effective professional communication. Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. 0 (0%) – 3 (3%) Responses posted in the Discussion lack effective communication. Response to faculty questions are missing. No credible sources are cited. Second Response: Timely and full participation 5 (5%) – 5 (5%) Meets requirements for timely, full, and active participation. Posts by due date. 4 (4%) – 4 (4%) Meets requirements for full participation. Posts by due date. 3 (3%) – 3 (3%) Posts by due date. 0 (0%) – 2 (2%) Does not meet requirements for full participation. Does not post by due date. Total Points: 100 Name: Discussion Rubric
Turn the brief into deliverables
- 01Three or four obstacles, each structural rather than attitudinal.
- 02An explanation of how professional socialisation persists.
- 03An account of why attribution is hard in health care outcomes.
- 04The failure mode of badly designed shared measurement.
- 05Research support for at least two obstacles.
Structural, professional and incentive obstacles
Why the easy explanation fails
Rule out motivational accounts and set the diagnostic standard.
Professional boundaries
Explain how separate training and licensure persist into practice.
Employment and economic alignment
Show how contracting structures separate mission from interest.
Attribution and measurement
Explain why shared accountability needs measurement it rarely has.
What the evidence supports
Bring research to at least two of the obstacles.
Research support is required, so plan for it
Recommended databases
- PubMed Central
- AHRQ Patient Safety Network
- Business Source Complete
- CINAHL
Search sequence
- 1.Search interprofessional collaboration and role boundary literature first.
- 2.Look for attribution problems in outcome measurement.
- 3.Find evidence on how employment model affects alignment.
- 4.Choose the obstacle with the strongest evidence as the post's spine.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Culture of Safety
AHRQ Patient Safety Network · 2024
How accountability is framed in safety culture, including the just-culture distinction.
- 02
Disruptive and Unprofessional Behavior
AHRQ Patient Safety Network · 2021
Evidence that boundary and hierarchy effects persist despite stated shared values.
- 03
Patient Safety and Quality
Agency for Healthcare Research and Quality, NCBI Bookshelf · 2008
The evidence base on teamwork and outcomes, for the attribution argument.
- 04
Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare
Journal of Healthcare Leadership · 2021
A review of implementation models, showing what makes shared arrangements hold or fail.
- 05
Value-Based Programs
Centers for Medicare & Medicaid Services · 2025
Programmes that attempt shared accountability through payment — the measurement problem made concrete.
Review before submission
Common mistakes
- Answering that people resist change or lack commitment.
- Describing what shared accountability looks like instead of why it fails.
- Ignoring employment structure, which often decides the question.
- Providing no research, when the prompt requires it explicitly.
Submission checklist
- Would each obstacle defeat a committed and well-intentioned team?
- Have you addressed measurement and attribution?
- Is employment structure considered?
- Are at least two obstacles supported by cited research?
Use this guide to plan and review your own work. Follow your institution's rules and read our academic-integrity policy.

Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.

Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.