Accountability in Ontario's Health Care System: The Role of Governance and Information in Managing Stakeholder Demands

This research focuses on nonprofit accountability because accountability failures, such as frauds and scandals, impede an organisation's ability to deliver on its mission and have raised concerns about an organisation's ability to manage their accountability demands.Previous nonprofit studies have focused on what accountability is and to whom organisations are accountable, while less focus has been given to how accountability is managed.Through the concepts of stakeholder relationships, governance mechanisms and information strategies, an accountability system is proposed and serves as the conceptual framework to understand how nonprofit accountability is managed.The objective of this research is to gain a better understanding of the nonprofit accountability system.As such, the study's research question is how do nonprofit organisations manage their accountability system?To answer the research question, a multiple-case study research strategy using a cross-sectional sample of health care organisations, with a particular focus on nonprofit hospitals and two of its salient stakeholders, Local Health Integration Networks (LHINs) and foundations.This study has provided a clearer understanding of the relationship between accountability, governance and information, which contrasts with a majority of studies that have concentrated on specific aspects of accountability.At the practical level, to iii view accountability as a system, makes it easier to identify weaknesses, which could be used as a governance tool to help nonprofit leaders improve their accountability management practices.Table 1-1 -Synthesis of Research Design Research theme Nonprofit accountability, governance and informationSource of the problem Practical problems: Accountability failures have raised concerns about the ability of nonprofits to manage their accountability demands and impede an organisation's ability to deliver on its mission.Accountability management is further complicated by resource constraints and a competitive external environment.Theoretical problems: Studies within the nonprofit sector have focused on what accountability is and to whom it should be given, not on what an accountability system might contain and how accountability is managed. Managerial problem How can nonprofit leaders improve accountability management practices?Research objective To gain a better understanding of the nonprofit accountability system. General research question How do nonprofit organisations manage their accountability system?Specific research questions How do nonprofit organisations use stakeholder relationships, governance mechanisms and information strategies to manage their accountability system?How do nonprofit organisations manage their stakeholder relationships?How do nonprofit organisations manage their governance mechanisms?How do nonprofit organisations manage their information strategies?How do nonprofit organisations manage their governance mechanisms?How do nonprofit organisations manage their information strategies?Type of Research Inductive and exploratory Epistemology Constructivism Research Approach Qualitative Research Strategy Case Study Data Collection Methods Interviews, Archival Documents Organisation and Participant Selection Health Care Sector Nonprofit organisations; Board members, Executives and Managers

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