A new paradigm on health care accountability to improve the quality of the system: four parameters to achieve individual and collective accountability

Healthcare systems the world over are facing significant financial pressures and growing demands for services. Many nations have therefore set common goal of improving the population's health, the quality of the outcomes, and the containment of costs [1]. A recent perspective considers health care systems as "high reliability organizations" (HROs), which are complex systems operating in a high-stress environment without losing sight of the objective to provide high quality results while still focusing on the assessment and management of risks [2]. So, the growing demand among patients for increasingly high quality treatments, the obligation to reduce adverse events in health care, the need for transparency in health care systems, and the current economic situation compound the difficulties in improving health care delivery. The debate on these issues now transcends national borders and single organisational, political and jurisprudential systems. Also, the problem of escalation of litigation in health care is applicable to all physicians regardless of age, geographical origin, and specialisation and it should be solved. Therefore, these changes in the health care systems' priorities have set the ground for an interdisciplinary approach necessary to assess the activities of health care professionals and, in general, of health care systems.