A spiritual leader will keep watch over the souls in his flock, since he has to give an account to God one day for each of them (Heb.13:17). What does it mean to give "an account" for people's souls? The word "account" is a financial word. If you're preparing a balance sheet and the income on the left side totals 5,000 rupees and the expenditure on the right side totals only 4,999 rupees, something is wrong. The difference may be only one rupee, but it is still a faulty statement of accounts. You have to account for that one rupee too, because accounting is a very exact science.
To render account to God therefore means that a leader must know exactly how things are going spiritually with his flock. He has to take this matter very seriously, because spiritual leadership is a more serious task than conducting a complicated surgical operation in a hospital. Lives are at stake - for eternity.
A leader is responsible for the believers in his church. He can't make them spiritual. But he must do everything to bring them into a living relationship with the Lord. His goal must be "to present every one of them perfect in Christ" (Col.1:28). He can't prevent them from backsliding, but he should have warned them before they do backslide.
When I was in the Navy, the shift system on the ships used to be called "watches". These were four-hour shifts, during which one officer would "keep watch" and be responsible for everything that happened on the ship. If I was "on watch" at sea, from midnight to 4 in the morning, I would have to stand on the "bridge" (the top part of the ship) with two or three sailors. All the others on the ship would be asleep. I would have to look out for other ships crossing our path and ensure that my ship was going in the right direction. I had to make course-corrections due to the drift caused by the wind and the waves. The safety of the ship and the direction the ship was going in, were all my responsibility during those 4 hours. I could not afford to sleep for even a minute during my "watch".
So when the Bible speaks about our "keeping watch" over others, this is a very serious matter. It requires alertness on the part of a spiritual leader to keep watch over people's lives, to ensure that they don't go astray, or drift away, or get lost.
Every good hospital has what they call "Daily rounds", when the doctors go around and check the condition of the patients. Those doctors don't just look out over all the wards in a general sort of way and decide that all the patients look healthy. No. They examine each patient individually. But what do many pastors do? They just look out at all their church-members on Sunday mornings and decide that everyone appears to be doing fine spiritually. But there are a lot of people who look very healthy on the outside who are actually very sick on the inside - both in hospitals and in churches! Some who look very healthy may be having "cancer" eating away their insides. It could be that some of those happy-looking people in your church who clap and shout "Hallelujah" may be having serious problems in their family-lives. As a doctor checks up each patient individually, a spiritual leader must also "check up"("keep watch over") each individual soul. The Bible exhorts all shepherds to "know well the condition of their flocks" (Prov.27:23).