The practice of medicine has numerous variables which make it vulnerable to human error, as implied by the title of the Institute of Medicine Report [13]. Although much has been learned about how and why errors occur, too many patients still perish at the hands of a system that struggles to find solutions. Within that system the delivery of care is shaped largely by providers who practice under the specter of a vast system for medical malpractice. Additionally, healthcare institutions might prioritize financial health over safety to ensure provider retention. These factors undermine the true needed accountability necessary to advance the improvement of healthcare [18].

The physician identity in historical context warrants examination. The assumed infallibility of physicians throughout history now reveals itself as a weakness. An individual viewed as perfect might develop a blind spot and avoid the introspection necessary to anticipate deficiencies. A future world must incorporate the implied responsibility for providers in ways that also acknowledges their vulnerabilities. Systems must continue to evolve which diminish the chance for error while maintaining a sense of autonomy for individual providers.

Providers are well-positioned to be agents of change for a stronger healthcare system. By taking ownership of accountability and accepting their own imperfections, medical professionals can rally for a new paradigm. A blend of blamelessness and accountability is better-suited for true quality improvement so that the objectivity of one system can complement the responsibility aspect of the other. This area of study should recruit the public’s trust as it seeks to undo damage from prior decades of contentious malpractice cases, medical errors, and revelations of other harm.

Ethics and accountability curricula have been modeled for undergraduate and graduate medical trainees [19, 20]. Combined with preeminent faculty stepping forward from such fields as surgery to offer a call to action, there is clear momentum to develop and disseminate best practices [21]. From this can flow ethical standards which must be integrated into clinical standards.

Patient safety is a concern for every person working in the world of healthcare. Indeed, only those so-inclined should be recruited for employment. The movement to protect patients from wrong-site surgeries, lethal dosing miscalculations, or other preventable adverse outcomes sits at a crossroads. The world of healthcare must engage all parties, particularly physicians and providers, in a team-based effort to build a coalition of accountability. If not, business as usual will disproportionately mete out accountability within a shroud of litigated fear. Justice and ethics will ensure that the science of accountability will grow and flourish as the system improves patient safety.