The National Patient Safety Agency has developed the Incident Decision Tree to help National Health Service (NHS) managers in the United Kingdom determine a fair and consistent course of action toward staff involved in patient safety incidents. Research shows that systems failures are the root cause of the majority of safety incidents. Despite this, when an adverse incident occurs, the most common response is to suspend the clinician (s) involved, pending investigation, in the belief that this serves the interests of patient safety. The Incident Decision Tree supports the aim of creating an open culture, where employees feel able to report patient safety incidents without undue fear of the consequences. The tool comprises an algorithm with accompanying guidelines and poses a series of structured questions to help managers decide whether suspension is essential or whether alternatives might be feasible. The approach does not seek to diminish health care professionals' individual accountability, but encourages key decisionmakers to consider systems and organizational issues in the management of error. Initial findings show the Incident Decision Tree to be robust and adaptable for use in a range of health care environments and across all professional groups. It is hoped that applying the tool throughout the NHS will encourage open reporting of actual and prevented patient safety incidents and promote a uniformly fair and consistent approach toward the staff involved.