Review ArticleAccountability: Challenges to Getting It RightDuthie, Elizabeth Ann RN, PhDAuthor Information From the College of Nursing, New York University; and MCIC Vermont, LLC, New York, New York. Correspondence: Elizabeth Ann Duthie, RN, PhD, 9801 Shore Rd, Apt 5-O, Brooklyn, NY, 11209-7566 (e-mail: email@example.com). The author discloses no conflict of interest. Journal of Patient Safety: March 2018 - Volume 14 - Issue 1 - p 3-8 doi: 10.1097/PTS.0000000000000161 Buy Metrics Abstract Patient safety experts debated accountability in health care at the 2014 annual National Patient Safety Foundation Congress. The debate reflected the struggles organizations are facing with ensuring a responsible workforce committed to patient safety versus the need to redesign flawed systems that are error prone. The question, “is it the systems or the individual?” was at issue. This article proposes that it is the wrong question, and the failure to apply patient safety science in clinical practice is contributing to the ambiguity fueling the debate. To transform accountability from a source of confusion to a powerful tool for fulfilling health care's fiduciary responsibility to protect patients from harm, we need to reframe our approach. This article presents the science and strategies to create clarity that will redirect the dialogue from a debate in which accountability resides to one about learning for improvement when adverse events occur. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.