This research focuses on nonprofit accountability because accountability failures, such as frauds and scandals, impede an organisation's ability to deliver on its mission and have raised concerns about an organisation's ability to manage their accountability demands. Previous nonprofit studies have focused on what accountability is and to whom organisations are accountable, while less focus has been given to how accountability is managed. Through the concepts of stakeholder relationships, governance mechanisms and information strategies, an accountability system is proposed and serves as the conceptual framework to understand how nonprofit accountability is managed.

The objective of this research is to gain a better understanding of the nonprofit accountability system. As such, the study's research question is how do nonprofit organisations manage their accountability system?

To answer the research question, a multiple-case study research strategy using a cross-sectional sample of health care organisations, with a particular focus on nonprofit hospitals and two of its salient stakeholders, Local Health Integration Networks (LHINs) and foundations.

This study has provided a clearer understanding of the relationship between accountability, governance and information, which contrasts with a majority of studies that have concentrated on specific aspects of accountability. At the practical level, to view accountability as a system, makes it easier to identify weaknesses, which could be used as a governance tool to help nonprofit leaders improve their accountability management practices.