Doctors, decisions, and discharges: Regulatory accountability for patient safety in a just culture

Leaving hospital is a dangerous time for patients. Within the English NHS, bed shortages have resulted in doctors being asked by NHS managers to discharge patients quickly, even where to do so is against a doctor’s clinical judgement. This is potentially problematic for doctors who, according to their regulator, are personally accountable and must be prepared to justify their decisions and actions. Taking this situation as its focus, this article argues that the regulator’s concept of accountability impedes its aim of fostering a just culture within healthcare. Given that a just culture is integral to ensuring patient safety, it is vital that this accountability problem is addressed. Three possible regulatory actions are presented to address this particular issue; it is anticipated that the recommended action could improve patient safety across the healthcare system.