Operationalizing Accountability for Integrated Care: A Qualitative Study of an Ontario Health Team.

Shared accountability is widely emphasized in integrated care theory and policy but remains underspecified in practice. This study examined how shared accountability was operationalized and experienced within an Ontario Health Team (OHT) using data from 23 semi-structured interviews with OHT stakeholders. Six interrelated factors that shape shared accountability were identified: perceived organizational identity, clarity of leadership roles and consequences for non-compliance, clarity of partner organizations' roles and consequences for non-compliance, management of goals and interests, trust and psychological safety, and power dynamics. Together, these factors highlight that shared accountability is not merely a matter of assigning roles or measuring outcomes; rather, it is a complex, relational process. These findings offer practical guidance for strengthening shared accountability in integrated care networks.