What have we learned from the substudies?

T T he findings suggest that accountability is increasingly seen as important. This scrutiny has both positive and negative implications. It forces providers to be aware of what they are doing, and to strive to improve their performance. Many of our respondents told us that there is an increased focus on quality. Accountability has moved beyond its traditional focus on financial dimensions (and ensuring that resources are not misappropriated) to add a major focus on performance. These are all positive outcomes. Yet our findings also suggest some warnings that should be heeded to ensure these benefits are realized while minimizing adverse unintended consequences. One clear signal arises from the examination of accountability " to whom. " Across many subsectors, but particularly within hospitals and the community, multiple bodies ask for similar information, but in different forms. The resulting costs and confusion can be considerable. A number of the papers in this Special Issue note that informants are concerned that their efforts are being diverted to reporting at the expense of front-line care. A related issue is accountability " by whom. " Complying with accountability requests appears more difficult for smaller organizations, which may not have the resources to respond to increasing requests for information. Respondents begin to see some of these requests as make-work, particularly when they must duplicate efforts for few perceived additional benefits. To the extent that multiple parties are seeking accountability, it would seem advisable for them to coordinate their efforts. As noted in the introduction (Deber 2014), there are a variety of policy goals that can be pursued, among them access, quality (including safety), cost control/cost-effectiveness and customer satisfaction. The accountability models and tools used may focus on various combinations of these. The substudies suggest the importance of clarifying what should EPILOGUE