Accountability for Medical Error: Moving Beyond Blame to Advocacy (Review)

Accountability for Medical Error: Moving Beyond Blame to Advocacy. CHEST 2011;140:519-526. 

Bell et al's great essay on the dysfunctional mechanics and culture of liability / safety / blame surrounding medical errors in hospitals and our medical care system in general. They propose steps toward "collective accountability," e.g., we MDs should sit on hospital safety committees. But what if hospitals' and physicians' general disregard for patient safety as a central, critical issue requiring systemic change is -- like virtually everything else -- largely driven by economic factors, and is a function of the payer / reimbursement system? You don't have to be callous or cynical to think so: the behavior of people and institutions -- good and bad -- is mainly determined by financial incentives, usually their without realizing it. If and when doctors and institutions are paid more to help keep people healthy than to bail out the boat when they're deathly ill -- then you might see a shift in values allowing a real culture of safety, accountability and integrity to emerge. But that's just my opinion. What do you think?