20 Healthcare Quarterly Vol.18 No.4 2016 Abstract This commentary presents an ethical argument and practical suggestions for holding health administrators accountable for quality improvement efforts and results. Using hockey analogies and drawing on evidence from various studies and literature in organizational ethics, it argues that health leaders must promote system performance by ensuring that there is a well-organized delivery system around patients’ episodes of care and that all personnel are performing at an accept- able level. Informed by system transformation and successes in the UK, this commentary proposes four strategies to hold leaders accountable: require leaders to be familiar with front- line operations, adopt a service-line approach, evaluate organ- izational performance by analyzing and publicizing outcome metrics and utilize outcome-based incentives. Introduction A National Hockey League Stanley Cup finalist in 2011, the Vancouver Canucks underperformed in subsequent seasons. The team’s president and general manager, Mike Gillis, was responsible for building the team and ensuring its on-ice success (MacIntyre 2014). After his team was eliminated from the post-season contention in 2014, he was fired, ending what some called a “reign of errors” filled with a spotty draft record, questionable trades and poor free-agent signings. This may seem like a harsh ending for a man who brought prior success to this hockey club. However, like healthcare, creating and maintaining successful team performance in hockey requires good leadership in coordinating a complex set of variables. It is a difficult task, and, in professional sports, it is very clear that those running the team will be held responsible for the ultimate results that are achieved. The same cannot be said for accountability in Canadian healthcare. Despite the 2002 report by the National Steering Committee on Patient Safety that called for a national, integrated strategy for improving patient safety and the estab- lishment of the Canadian Patient Safety Institute by Health Canada in 2003 (Baker 2004), the latest Commonwealth Fund report (2014) rated the Canadian healthcare system as one of the “worst-performing” systems. The report puts it at number 10 on the overall ranking of 11 systems, only above the United States. Taking a page from the hockey playbook and looking at the substantial quality and efficiency improvements in the UK after an overhaul of its National Health Services (NHS), this commentary argues that the ultimate accountability for health- care performance should lie with those who organize and oversee the systems. Where Lies the Responsibility Since the release of the Institute of Medicine (IOM) reports, To Err is Human (1999) and Crossing the Quality Chasm (2001), there has been an increasing acknowledgement that poor systems of care contribute to most quality failures. The Puck Stops Here: Taking Organizational Accountability Seriously Stephen Pinney and Anita Ho LEADERSHIP PERSPECTIVE