The Effect of Outcome vs. Process Accountability-Focus on Performance: A Meta-Analysis

Abstract

BackgroundThe foundation of a safe practice is accountability, especially outcome- rather than process-focused accountability, particularly during pandemics such as COVID-19. Accountability is an essential behavior that promotes congruence between nursing actions and standards associated with quality of care. Moreover, the scant research examining whether one accountability focus is superior in motivating humans to better task performance yields inconclusive results.AimsSystematically examine the effect of an outcome- vs. process-accountability focus on performance and identify any moderating variables.DesignSystematic review and meta-analysis.Data sourcesPsycINFO, Medline, PubMed, Scopus, and CINAHL databases, with all publications to November 2020.Review methodsA systematic search using Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Statistical analysis and forest plots were performed using MetaXL 5.3. Heterogeneity was presented using I2 statistics and Q tests, and possible publication bias was assessed with a Doi plot and the LFK index.ResultsSeven studies representing nine experiments involving 1,080 participants were included. The pooled effect of the nine experiments on task performance failed to show significant differences (mean = −0.09; 95% Confidence Interval [95%CI]: −0.21, 0.03), but a significant moderating effect of task complexity was demonstrated. Specifically, outcome accountability exerts a beneficial effect in complex tasks (mean = −0.48 [95%CI: −0.62, −0.33]) whereas process accountability improves the performance in simpler tasks (mean = 0.96 [95%CI: 0.72, 1.20]).ConclusionThese findings demonstrated that accountability focus by itself cannot serve as a sole motivator of better performance, because task complexity moderates the link between accountability focus and task performance. Outcome accountability exerts a beneficial effect for more-complex tasks, whereas process accountability improves the performance of simpler tasks. These findings are crucial in nursing, where it is typically assumed that a focus on outcomes is more important than a focus on processes.

Accountability focus and nurses' performance: A moderated‐mediation model by using experiment design simulations

“…Our finding supports several previous studies demonstrating that process accountability better suits complex tasks and that outcome accountability better suits simpler tasks (Hall et al, 2017; Patil et al, 2014, 2017). However, the results also contradict those of a recent meta‐analysis (Sharon et al, 2022) demonstrating that under process accountability, simple tasks were performed more precisely, and that under outcome accountability, complex tasks achieved better results. These conflicting findings may be explained by how complex tasks are defined and operationalized.…”

“…First, our findings supported recent studies indicating that there is no superior accountability‐focus mechanism that motivates workers to higher performance (Davis et al, 2007; Häusser et al, 2017; Sharon et al, 2022). Yet, our findings indicated that the impact of an accountability focus on performance critically depends on the type of task performed through the mediation of strain.…”

“…Indeed, a meta-analysis combining the findings from nine experiments outside the nursing context highlighted that the link between accountability focus and performance may be moderated by task complexity. Note that in that meta-analysis, performance was tested in a moderation of task complexity directly on the outcome and not through the mediator of strain (Sharon et al, 2022). Moreover, this issue was not examined in real-life work contexts in nursing.…”