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Conscious Accountability in Clinical Work

November 14, 2022

​In addition to cutting-edge research, a significant part of the Yale Child Study Center’s mission involves the delivery of clinical services to children and their families. In this month’s column “On Leadership” Daryn David addresses how the principles of conscious accountability can inform work in the clinical realm.

First, a refresher! Conscious accountability is defined as “expanding awareness to create deliberate intentions, take informed actions, and be responsible for your impact.” What this means is that when we engage with others in a task, we not only consider our end-point deliverable, but give equal, conscious attention to our process of working together and, ultimately, what we have learned from our collective efforts.

Clearly establishing expectations, building psychological safety and commitment to shared goals, and making a full effort to actualize the results we set out to achieve are the first three steps of the process. Curiously exploring how we are doing, exchanging feedback about our process, owning our outcomes, and considering changes we might like to make as we reengage are additional steps that privilege the interpersonal dimensions of working together.

Teamwork has always been a key cornerstone of how clinical medicine is practiced at the YCSC. Effective teamwork ­- in which clinicians feel comfortable calling on one another for support, empathize with one another around the stresses that they are facing, and speak honestly with one another about how they are performing individually and as a team - can help to buffer the emotional demands of the work.

The need for this type of support may be particularly acute now, given the sharp increase in mental health concerns amongst children and their families since the onset of the pandemic – and the enormous strain many clinicians at the YCSC, across the YSM healthcare system, and beyond have therefore experienced.

Overtly grounding our clinical teams in some of the core conscious accountability practices is another way to foster our collective resilience in providing clinical care. For example, team leaders could actively and deliberately check in about how safe clinicians are feeling to ask for help from one another.

Clinicians can also be encouraged to notice and provide feedback to one another if it seems that someone on the team is straining more than usual. Taking honest stock of what it is like to be in this difficult moment together, and conveying appreciation for all of the teamwork that is taking place, can be of tremendous help.

And, finally, there is the importance of beginner’s mind! So many of the conscious accountability practices encourage us to bring humility, a spirit of open inquiry, and a growth mindset to our endeavors. These mindsets can prove golden when trying to really listen to and connect our patients, and in supporting one another in doing this crucially important work.

Submitted by Crista Marchesseault on November 10, 2022