Leaders often talk about empowering their teams. Leaders encourage staff to take initiative, make decisions, and assume ownership of their practice. Yet despite these good intentions, team members may still find themselves asking, “Am I actually allowed to make this decision?”
The challenge is not necessarily a lack of initiative or willingness to take ownership. Often, it is a lack of clarity. Without clarity, even well-intentioned efforts to empower teams can create confusion rather than ownership. In Creative Health Care Management’s Leading an Empowered Organization® (LEO) framework, empowerment begins with clearly articulated expectations and rests on the foundation of three essential pillars: responsibility, authority, and accountability.
Responsibility is the allocation and acceptance of activities, actions, decisions, and planning, , authority clarifies the right to act on those responsibilities , and accountability involves reviewing decisions and evaluating effectiveness. Together, these pillars create the clarity needed for empowered practice.
Responsibility: What do I commit to doing?
Responsibility involves more than assigning a task. It requires a shared understanding of what needs to be accomplished and an agreement about who will take ownership. Leaders must communicate expectations, but team members must also understand and accept their responsibilities. This two-way process helps ensure that responsibility is not simply assigned but mutually understood and accepted.
Authority: Who has the right to decide?
Giving someone responsibility without the authority to act can quickly limit empowerment and lead to frustration. There are varying levels of decision-making authority, and leaders must clearly communicate what authority individuals and teams have before they begin their work. The level of authority is determined by the nature of the decision or activity, not by an individual’s position or title.
Four Levels of Decision-Making Authority
- Level 1: Gather Information: The team is responsible for collecting relevant information, such as reviewing patient experience data or researching evidence-based practices and sharing their findings. Decision-making authority remains with the leader.
- Level 2: Make Recommendations: The team gathers and analyzes information, identifies potential solutions, and recommends a course of action. The leader may consider the input but retains the authority to make the final decision. This reflects a participatory management approach.
- Level 3: Communicate, Clarify, and Act: The team gathers and analyzes information, develops a proposed plan, and pauses to communicate with leaders and other stakeholders, clarify expectations, and gather feedback before taking action. This pause is not to seek permission or approval, but to ensure that relevant perspectives have been considered and the decision is within established expectations and guardrails. Within those guardrails, the team has the authority to make and implement the decision. This is where shared and professional governance occurs.
- Level 4: Act and Inform: The authority to act independently within established responsibilities and communicate their actions afterward. This level is generally reserved for situations where independent action is appropriate and is not common in shared governance council decisions.
Moving From Input to Decision-Making
In shared and professional governance, the goal is to move beyond simply asking staff for input toward enabling those closest to the work to make meaningful decisions about their practice and practice environment within established guardrails.
The distinction between these levels of authority is important. Asking staff for input is not the same as empowering them to make decisions. While all four levels have a purpose, empowering your teams requires clarity about when professionals have the authority to move beyond providing recommendations to making decisions about their practice and practice environment.
When authority is clearly defined, professionals can confidently exercise autonomy within established expectations, and leaders can provide support without unnecessarily controlling the process.
Accountability: How do we know if the decision was effective?
Once decisions are made, we need to evaluate whether our actions achieved the desired outcomes.
- Did we achieve the intended outcomes?
- What worked?
- What did not?
- What should we do differently?
This reflection guides future actions and creates opportunities for learning and continuous improvement, rather than simply serving as a mechanism for oversight.
Putting Responsibility, Authority, and Accountability Into Practice
Consider a nursing council working to improve a patient education process. The council is given and accepts responsibility for reviewing the current process and developing improvements. Level 3 authority includes revising the process within established clinical, budget, and organizational requirements, communicating and collaborating with relevant stakeholders and clarifying expectations before implementation. Accountability involves reviewing agreed measures of success to determine whether the changes achieved the intended outcomes.
Before the work begins, leaders and council members need a shared understanding of each element. What is the council expected to accomplish? Which decisions can it make? What guardrails apply? How and when will outcomes be evaluated? Making these expectations clear helps the team move forward with confidence.
Tying it all together: R+A+A
Together, these three pillars create the conditions for empowerment and professional autonomy. The leader’s role is to articulate the vision, establish clear expectations and guardrails, provide necessary resources and support, and help remove barriers. The team’s role is to accept responsibility, exercise appropriate decision-making authority, and evaluate the effectiveness of its actions. When responsibility, authority, and accountability are clearly understood and mutually accepted, teams can move beyond waiting for permission and begin taking ownership.
Leaders provide clarity and support.
Teams create the solutions.
Together, they achieve excellence.
Creating Clarity and Empowerment with CHCM
At CHCM, we believe meaningful empowerment requires more than encouraging staff to participate in decisions. Our shared and professional governance and leadership development solutions help healthcare organizations establish the structures, processes, and leadership practices needed to support professional autonomy and ownership at the point-of-care.
Explore how CHCM can help your organization strengthen shared governance and create the conditions for empowerment by contacting us today.
Frequently Asked Questions About Responsibility, Authority, and Accountability
Responsibility is the commitment to carry out agreed work. Authority is the right to make decisions and act within established expectations. Accountability involves following through and evaluating whether actions achieved the intended outcomes. Healthcare teams need clarity about all three to take meaningful ownership of their practice.
The four levels described in CHCM’s LEO framework are:
1. Gather Information: Collect and share information; the leader makes the decision.
2. Make Recommendations: Analyze information and propose a course of action; the leader retains the final decision.
3. Communicate, Clarify, and Act: Develop a plan, pause to communicate with stakeholders, clarify expectations, and then implement the decision within established guardrails.
4. Act and Inform: Act independently within established responsibilities and communicate afterward.
When teams are responsible for work but lack the authority to make the decisions needed to carry it out, they may experience delays, frustration, and uncertainty. Clearly defining decision-making authority helps teams understand when they can act and when a decision remains with the leader.
References:
Creative Health Care Management (2023). Leading an empowered organization. Minneapolis, MN: Creative Health Care Management, Inc.
Guanci, G., & Medeiros, M. (2024). Shared governance that works. Creative Healthcare Management.
Medeiros, M., & Guanci. (Ed.). (2025). Considerations in professional governance. Creative Health Care Management.
Van Wagoner, K., & Martin, T. (Eds.). (2025). Essentials of a caring culture: The interprofessional relational model. Creative Health Care Management
This content was developed under human authorship and editorial oversight, with optional support from AI tools used to enhance clarity and efficiency.
Amber’s deep understanding of data, attention to detail, and drive for creating a culture of excellence offers her clients a strong advantage. With her impressive background as a clinician and leader within a large health system she knows how to motivate others and unlock the potential in individuals and teams. Her work in engaging and leading teams through the strategic planning process by aligning organizational goals with unit and department goals has led to staff understanding of the big picture and collaborative relationships with those from the point of care to those in executive suites.
