While the patient safety field has emphasised ‘systems thinking’ as its central theme, 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 (such as peers, patients, healthcare systems or regulators) versus professionals themselves (‘professionalism’). 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 USA. Ultimately, a robust approach to patient safety will balance ‘no blame’ with accountability, and will also parse the correct target for accountability in a way that maximises fairness and effectiveness.
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