Patient safety and the problem of many hands.

Dixon-Woods M, Pronovost PJ. BMJ Qual Saf. 2016 Feb 24; [Epub ahead of print].

Although individual and organizational accountability are important elements of safety, they can also hinder system-wide improvement. This commentary discusses challenges to coordinating actions and accountability among and throughout the various components inhealth care, such as hospitals, governmental agencies, insurers, and accreditors. To achieveimprovements, the authors propose that health care needs to establish a collective responsibility to develop collaborative solutions that balance global standards with local interventions.