Managing risk: systems approach versus personal responsibility for hospital incidents

As hospitals grapple with the intense scrutiny of medical errors, administrators may find themselves in the midst of conflicting approaches to improving overall patient safety. One approach to addressing incidents that have been caused by individual practitioners is to consider weaknesses in the system of care at multiple levels that may have enabled an incident to occur. An alternative approach is to hold the individuals responsible for their performance errors and to impose penalties that have specific consequences for those individuals. These two approaches, though not mutually exclusive, can produce conflict among staff.