Promoting Professional Accountability Programme

An evidence-based framework that builds a high-performance culture of safety and reliability, and addresses individual behaviours that may undermine it.

In partnership with Vanderbilt University

The Promoting Professional Accountability (PPA) Programme provides healthcare organisations with a sustainable, organisation-wide framework and training to achieve the highest levels of safety and reliability.

The programme builds on the professionalism and commitment of the overwhelming majority of staff, while ensuring the actions of no one individual can undermine a culture of safety and reliability. 

Published research has discussed the effectiveness of the programme, or its components, in areas relating to hand hygiene [1], self-regulation [2] and reduced complaint risk [3].

The PPA Programme is suited for any healthcare organisation focused on achieving the highest possible quality and safety levels, whether already an exemplar or one committed to significant improvements. 

The programme can be implemented in a single unit through to the entire organisation.  


  • Improved patient safety attributable to greater staff willingness to speak up; first to colleagues and, when necessary, reporting incidents
  • Improved staff satisfaction and retention
  • Enhanced reputation for the organisation, board and executive
  • Reduced costs through greater reliability and reduction of unwanted variability
  • Creation of a culture of professionals who are important role models for students, residents, staff, and each other
  • Reduced liability exposure and risk management activity
  • Overall more productive, civil, and desirable work environments
  • Engagement of clinicians at all levels.

Stages of implementation

1. Commitment

This stage aims to inform board and executive members about the PPA Programme, the evidence underpinning it and the organisational infrastructure required to support accountability. It identifies the impact professional accountability has on a culture of safety and the delivery of quality patient outcomes. It will outline the role of the board and executive in implementing this programme and the commitment needed for its success.

2. Readiness

This stage prepares the organisation to implement the PPA Programme. An analysis of the organisational infrastructure is carried out to identify any gaps that may impact the ability to address disruptive behaviours and support a culture of accountability and safety. A plan will be developed to address any infrastructure gaps to ensure the effective implementation of the PPA Programme.

3. Implementation

This stage provides the necessary training required to implement the PPA Programme including:

  • All-staff seminars, so everyone in the organisation has an understanding of the PPA Programme.
  • Peer messenger training to equip participants with the skills needed to address unprofessional behaviour and respond appropriately to pushbacks or resistance.
  • Leadership training for leaders who review and manage behaviour that undermines a culture of safety.
  • Coaching and feedback support for leaders and peer messengers to support their ongoing effective implementation of the programme and to ensure a sustainable programme.

For more information download the programme brochure or contact:
Louise Cuskelly
Senior Education Consultant
+61 7 3511 5082
Email enquiry


(1) Tabot TR, Johnson JG, Fergus C, Domenico JH, Schaffner W, Daniels TL, Wilson G, Slayton J, Feistritzer N, Hickson GB. Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives. Infect Control Hosp Epidemiol. 2013 Nov 1;34(11):1129-36.

(2) Webb LE, Dmochowski RR, Moore IN, Pichert JW, Catron TF, Troyer M, Martinez W, Cooper WO, Hickson GB. Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals. Jt Comm J Qual Patient Saf 2016; 42(4):149-64

(3) Hickson GB, Cooper WA. Pursuing Professionalism (But not without an infrastructure). In: Byyny RL, Papadakis MA, Paauw DS, editors. Medical professionalism: best practices. Melo Park, California: Alpha Omega Alpha Honor Medical Society; 2015. p. 81-98.