How to Hold People Accountable When It Does Not Come Naturally

Let’s be honest. Most leaders were never taught how to hold people accountable.They were promoted because they were high performers, strong clinicians, great operators, or team anchors. Not because someone trained them in the emotional skill of having hard conversations.

So when the moment comes to address performance, behavior, or expectations, many leaders try to avoid discomfort.They wait.They soften the message.They hope things resolve themselves.

And then the culture suffers.

The good news is that accountability is a learned skill grounded in emotional intelligence, not personality.

Here is how to start building it.

1. First things first: Set clear expectations upfront

You cannot hold someone accountable to something that was not clearly defined.

Most accountability breakdowns happen before the critical conversation, not during it.

When expectations are vague, inconsistent, or assumed, leaders end up policing behavior instead of guiding it. And employees feel blindsided, not supported.

A strong foundation includes

• what you expect

• why it matters

• how success will be measured

• when you will review progress

And here is the part most leaders skip: the why behind the expectation.

People follow clarity, not ambiguity. They commit when they understand why it matters.

In healthcare especially, where pressure is high and time is tight, clarity is not a luxury. It is oxygen.

2. Explain the why behind expectations and go deeper than you think

Research from Harvard shows that employees are more than three times as likely to stay engaged when they understand the purpose behind their work.

The same applies to accountability.

When you anchor expectations to

• safety

• patient experience

• team consistency

• operational flow

• high reliability

people see the bigger picture. And when employees feel connected to purpose, accountability becomes a shared commitment, not a policing act.

3. When it is time for the hard conversation, regulate first

This is where emotional intelligence becomes your superpower.

Self regulation determines whether a leader addresses the issue with clarity or with frustration. People can hear accountability. They cannot hear anger.

Harvard Business Review research shows that leaders who regulate their emotions are rated as more competent, trustworthy, and fair.

Before the conversation, ask yourself

• What outcome do I want

• How do I want them to feel

• Am I grounded enough to be present

If you are not regulated, pause. A sixty second reset can change the entire conversation.

4. Be direct but not harsh

Directness is clarity. Harshness is ego.

Most leaders avoid being direct because they fear being unkind. But being vague is actually far more damaging.

Direct and calm language sounds like

I want to talk about your documentation. Here is what I am seeing. Here is the impact. And here is what needs to change.

No blame. No shame. Just clarity.

5. Keep accountability future focused

Accountability is not about punishment. It is about movement.

Shift the conversation from

What went wrong

to

What needs to happen going forward

Forward focused conversations build trust.

Backward focused ones build defensiveness.

6. Document agreements because clarity protects relationships

Accountability conversations should end with

• clear next steps

• timelines

• what support is needed

• when you will check in again

Documentation is not about control. It is about alignment.

7. And finally remember you are not bad at accountability. You are unpracticed.

Accountability is not a personality trait.

It is a muscle.

You become better by practicing.

By regulating.

By preparing instead of reacting.

By leaning into discomfort rather than away from it.

And the more you strengthen your emotional intelligence, the easier these conversations become.

Nearly seventy percent of leaders say accountability is their hardest skill. You are not alone.

But it is absolutely learnable.

And once you learn it, you do not just become a better leader. You build stronger teams. You create healthier cultures. And you reinforce trust through clarity.

Accountability is not the opposite of empathy. It is a form of it.