Accountable Care Unit Implementation: A Mixed-Method Analysis

Raghad AlSakaji, Simi Shailamma, Mahmoud Kiblawi, Deanne Kashiwagi


In a study conducted at Sheikh Shakhbout Medical City in Abu Dhabi, UAE, the implementation of an Accountable Care Unit (ACU) led to improved clinical outcomes, patient satisfaction, and care team collaboration.

0 %
reduction in length of stay
0 %
increase in readmission rate


To perform a quantitative and qualitative assessment of outcomes related to care team communication, collaboration, efficiency, and effectiveness of care and patient experience following the implementation of an ACU.


The study involved the restructuring of a General Medicine ward at a 473-bed hospital into an Accountable Care Unit (ACU) using multiple PDSA (Plan-Do-Study-Act) cycles. Physicians were assigned to units with care team members where they participated in daily Structured Interdisciplinary Bedside Rounds (SIBR) with oversight by nurse and physician leadership dyads. Data were collected on length of stay (LOS), readmissions, patient satisfaction, and care team communication pre- and post-implementation.


Length of Stay (LOS):

• Decreased from 7.2 to 6.5 days post-implementation in the pilot unit.

Readmission Rates:

• Decreased from 1.7 to 1.3 post-implementation.

Clinical Management Index (CMI):

• Increased from 1.55 to 1.64 in the pilot unit.

Patient Experience Scores:

• Trust/Confidence in Physician: Increased to 96th percentile.

• Physician Kept You Informed: Increased to 94th percentile.

• Nurses Kept You Informed: Increased to 58th percentile.

• Likelihood to Recommend Primary Physician: Increased to 37th percentile.

• Likelihood to Recommend Hospital: Increased to 56th percentile.

Care Team Communication:

• Significant improvements in care team communication and collaboration were reported.

• Care team survey responses indicated increased agreement with statements about knowing the daily plan of care and effectively communicating this plan with all team members.


The implementation of the Accountable Care Unit (ACU) at Sheikh Shakhbout Medical City significantly enhanced clinical outcomes, patient satisfaction, and care team collaboration. These results highlight the value of the ACU model in fostering effective teamwork and improving patient care experiences.

I hope you enjoyed reading these strong results. Unit outcomes like these are achievable within 3 to 6 months using a seasoned implementation methodology:

  1. skillful project management
  2. smooth training and launch, and a
  3. long-term partnership for sustainability.

One option to achieve similar results is to engage our 1Unit experts. Backed by 15 studies like this one, our work has received awards from The Joint Commission, CMS, Clinical Excellence Commission, IHI, BMJ, and the Society of Hospital Medicine.

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Liam Chadwick, PhD