Purpose This paper aims to analyse the role of communication in shaping the mechanisms of accountability routines. Design/methodology/approach Conceptual elements of the theory of communicative action and the literature on routines were used to conduct a field study in two hospital districts in Finland, from 2009 to 2015. Data were based on interviews, document analysis, observed meetings and repeated contact with key informants. Findings The findings explain how accountability routines take different forms - weak or strong - in different organisations and at different hierarchical levels. Differences depend on the generative structures and mechanisms of the communicative process - relational and normative - used to give and ask information to and from organisation members involved in accountability relationships. An explorative finding is that discourse-based communication plays an important role in bridging the gap between weak and strong accountability routines. The main theoretical contribution is to conceptualise and show the role of communicative rationalities in shaping the mechanisms of accountability routines. Practical implications - The implication for practitioners and policymakers is to show to what extent the organisation policies and communicative rationalities used in accountability have potential to improve or not to improve the practices of accountability routines. Mutual understanding, motivation and capacity of organisation members to do as expected and agreed upon without pressure improve accountability routines. Originality/value The value of this study is to explain how accountability routines take different forms in practice (weak or strong) in different organisations and at different hierarchical levels, depending on the generative structures of the communicative process used in practicing accountability routines.