1. Accountability: To Whom? For What?
Lucian L. Leape, MD
Harvard School of Public Health
10th Anniversary of To Err is Human
The Commonwealth Fund and Alliance for Health Reform
March 17, 2010, Washington, DC

2. Accountability today Blame and punish – Who will be fired?
Mandatory reporting – Serious Reportable Events
No pay for Serious Reportable Events

3. Accountability today – what’s wrong
Retrospective – after the patient has been harmed
Blame and punishment all over again
Safety is about prevention - prospective
We don’t want to hold people accountable for hurting people, we want to hold them accountable for NOT hurting people

4. A shared vision of what health care can be
Provided by an organization that is responsible for all the health needs of a population
Care that is evidence-based, patient-centered, safe, timely, efficient, and equitable
In an environment that is transparent, non-punitive, supportive, but accountable
By caregivers who are competent, compassionate, and collaborative, and share a sense of responsibility

5. Prospective Accountability
Individual
Institution
Regulator

6. Prospective Accountability
Individual
Technical competence – keeps up
Social competence – respect, empathy, collaboration
Accountable – follows safe practices, works to improve
Institution
Regulator

7. Prospective Accountability
Individual
Institution
Provides a safe, non-punitive environment – a “just” culture
Implements all known safe practices
Provides the resources and training needed
Monitors practices
Monitors performance
Takes corrective action when needed
Regulator

8. Prospective Accountability
Individual
Institution
Regulator
Sets standards for practice and performance
Safe practice – NQF list
Environment, working conditions
Credentialing
Worker safety
Monitors compliance
Sanctions when necessary

9. Reciprocal Accountability
Regulators
Hospitals
Professionals

10. Reciprocal Accountability
Regulators
Patients
Hospitals
Professionals

11. Do we need a Federal Patient Safety Agency?