Defining and Assigning Accountability for Quality Care and Patient Safety

The prevalence of avoidable patient harm and preventable patient death in U.S. hospitals is widely acknowledged, yet legal and regulatory efforts to safeguard the public have had limited effect. Systems theory suggests that variations in practice and organizational deficiencies often result from the interdependencies and bidirectional effects of the parts on the whole. In health-care delivery, where many individuals and systems influence outcomes, a conundrum exists regarding how to assign accountability for preventable harm. When it is assigned, the question becomes how to administer sanctions with fairness to patients and families, clinicians involved in the error, and the institutions where the error occurs. This article discusses the regulatory challenge of defining accountability for quality and patient safety, suggests perspectives regulators should consider in balancing competing interests, and challenges regulators to lead the development of principles for team-based accountability.