LEAD 6523 Module 4 Accountability Measures and Reporting Plan Example

Measures for Five Audiences and One Safety Rule: An Accountability and Reporting Plan for a Rural Community Paramedicine Program

Student Name

American College of Education

LEAD6523: Planning, Evaluation, and Accountability

Module 4 Assignment

Instructor Name

November 2, 2026

Introduction

Once it is running, the program will owe explanations to several audiences: the county commission, which funds the ambulance service; the regional foundation, which funds the program's first two years; the critical access hospital and clinic, which are partners; the crews, who carry out the work; and patients and their families. Each wants something different from performance information. This paper builds an accountability plan that chooses measures by purpose, guards against a measure that could harm patients and sets out how results will be reported and used.

Measures Serve Purposes

Behn (2003) argued that public managers measure performance for eight distinct purposes, to evaluate, control, budget, motivate, promote, celebrate, learn and improve, and that no single measure serves them all. A measure useful for budgeting, such as cost per patient, may be useless for motivating crews; a measure useful for learning, such as the reasons patients called, may be meaningless to a commission. The plan below therefore starts with purposes and audiences and only then chooses measures, rather than compiling a single dashboard and sending it to everyone.

Measures by Audience

For the county commission, whose purposes are evaluating and budgeting, the plan reports four measures quarterly: ambulance transports by enrolled patients compared with the matched group, hours with no ambulance available in the county, program cost per enrolled patient and estimated costs avoided. For the foundation, whose purpose is evaluating its grant, the plan reports, twice a year, the five dimensions of public health impact used in the evaluation design (Glasgow et al., 1999): reach, effectiveness, adoption, implementation and maintenance. For the hospital and clinic, whose purposes are improving and coordinating care, the plan shares monthly lists of enrolled patients' readmissions and missed follow-up appointments. For crews, whose purposes are learning and motivating, the plan shares a monthly summary of visits, patient stories shared with consent and field referrals by station. For patients and families, the program reports at enrollment and every six months what it has done for them and how they can reach it. The state emergency medical services office, whose approval the program sought for its expanded protocols, will receive an annual summary of visits, protocols used and any adverse events, as agreed when the protocols were approved.

A Measure That Could Harm

One measure needs special care. The program's central claim is that enrolled patients will call 911 less. If paramedics or managers come to see fewer calls as the goal in itself, a paramedic might, even unconsciously, discourage a frightened patient from calling for an ambulance when one is needed. A program built to reduce unnecessary calls must never become a program that discourages necessary ones. The plan therefore includes a balancing measure and a rule. The balancing measure is the number of enrolled patients who suffered a serious event, such as a cardiac arrest or an admission to intensive care, after a delay in calling. The rule, written into every patient's enrollment agreement and repeated at every visit, is that patients should always call 911 for an emergency, and paramedics will be evaluated on patient health, not on call counts.

Turning Data Into Use

Reports alone do not produce accountability or improvement. Moynihan and Pandey (2010), studying why public managers use performance information, found that use depended substantially on organizational conditions, among them a culture that supports learning and leadership that values the information, rather than simply on how much data was available. The plan therefore pairs reporting with a forum: a monthly program review meeting, chaired by me, at which paramedics, the clinic's nurse practitioner and the hospital's discharge planner review the month's measures and decide on one change to try. Quarterly, the review includes the county's emergency medical services director and a commissioner.

Accountability to Patients

Accountability usually flows upward to funders, but a program that enters people's homes owes accountability to them as well. Each enrolled patient will receive a one-page summary every six months of what the program has done with them: visits made, medication changes recommended and referrals arranged, with the name and number of their paramedic. Patients and families will be asked two questions at each summary, whether the visits helped and what the program should do differently, and their answers will be read at the monthly review. Two former frequent callers, or family members, will be invited to the annual public report to speak if they wish. This kind of accountability is not measured by any funder, but it is what makes patients trust the program enough to keep opening their doors.

Reporting Calendar

Monthly: crew summary, partner patient lists and the program review meeting. Quarterly: commission report and safety review of the balancing measure. Every six months: foundation report and patient updates. Annually: a public report to the county commission's open meeting, written in plain language with the year's results, costs and changes made. At the end of the grant: the outside evaluator's report on effectiveness and cost, presented with the program's recommendation on whether to continue.

Data Quality and Privacy

Accountability depends on trustworthy numbers. The program's data coordinator will reconcile visit records against the dispatch system monthly, and a random sample of ten visit records will be checked each quarter against patient charts. Patient-level data will be shared only with partners covered by the data-sharing agreement; reports to the commission and the public will contain only aggregate figures, suppressed when fewer than ten patients are involved, so that no individual can be identified in a small county.

When Results Disappoint

A good accountability plan prepares for bad news. If the evaluation finds that enrolled patients call no less than the comparison group, the plan commits the program to report that result to the commission and the foundation in the same format as a good result, together with what the program has learned about why. The monthly review will have produced a record of changes tried, which makes it possible to say whether the program failed in design or in delivery. Funders tend to trust programs that report failures honestly more than programs whose reports are always good.

What the Plan Avoids

The plan deliberately avoids three common mistakes. It does not report visit counts as success, since visits are outputs, not outcomes. It does not compare stations' referral counts in a way that ranks crews, which could encourage inappropriate referrals. And it does not promise the commission savings before the evaluation can estimate them, which would set expectations the program might not meet.

Conclusion

Accountability, in this plan, means giving each audience the information it needs for its own purpose, protecting patients from the misuse of the program's headline measure and building a forum where data lead to decisions. The plan reports less than a single dashboard would, but each measure has a reason, an owner and a use. Its success will show less in any single report than in whether partners, crews and patients come to trust the numbers enough to act on them.

References

Behn, R. D. (2003). Why measure performance? Different purposes require different measures. Public Administration Review, 63(5), 586-606. https://doi.org/10.1111/1540-6210.00322

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

Moynihan, D. P., & Pandey, S. K. (2010). The big question for performance management: Why do managers use performance information? Journal of Public Administration Research and Theory, 20(4), 849-866. https://doi.org/10.1093/jopart/muq004