Key points

  • While the patient safety field has emphasised as its central theme ‘systems thinking’, experts have pointed to the need to balance this ‘no blame’ approach with the need for accountability in certain circumstances, such as failure to heed reasonable safety standards.
  • Our growing appreciation of the importance of accountability raises several new questions, including the relative roles of personal versus institutional accountability, and the degree to which personal accountability should be enforced by outside parties versus professionals themselves.
  • Identifying the appropriate locus for accountability is likely to be highly influenced by the structure and culture of the healthcare system; thus, answers in the UK will undoubtedly be different from those in the US.
  • A robust approach to patient safety will not only balance ‘no blame’ with accountability, but will also parse the correct target for accountability in a way that maximises fairness and effectiveness.

Professor Robert Wachter explores the issue of personal accountability in healthcare and describes how accountability for performance is a key element for a safe system.

Research shows that when patient safety breaks down, it is usually caused by clinical processes and systems rather than individuals. The Health Foundation’s improvement programmes help healthcare organisations to redesign unreliable processes and to develop a culture that supports patient safety with strong leadership, accountability and enthusiasm.

Health Foundation thought papers are the author’s own views. We would like to thank Professor Wachter for his work, which we hope will stimulate ideas, reflection and discussion.

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