South Africa’s healthcare system must move beyond blaming individual clinicians when patients are harmed and confront the institutional failures that allow medical errors to reach patients, the head of the country’s health standards regulator told the conference.
Dr Siphiwe Mndaweni, CEO of the Office of Health Standards Compliance (OHSC), said accountability must extend from individual healthcare professionals to hospital management, governance structures and the wider health system, reports Chris Bateman for MedicalBrief.
“When a patient is harmed, accountability cannot end with identifying the person who made the error,” she emphasised.
The challenge, she argued, is to establish reliable systems that prevent harm, encourage the reporting of mistakes and near-misses, and ensure that identified risks trigger corrective action rather than simply being recorded. The implications extend beyond patient safety to the costly medico-legal disputes facing government, where failures in clinical care can expose the state to litigation and compensation claims.
While Mndaweni did not quantify the contribution of OHSC interventions to reducing claims, her central message was that preventing avoidable harm requires effective governance, adequate resources, reliable reporting and demonstrable improvements in care.
Reporting must lead to corrective action
Healthcare accountability is frequently misunderstood as a mechanism for punishment, she said. Instead, it should create an environment in which staff feel safe to report errors and raise concerns without automatically fearing retribution.
A “just culture” recognises that human error is inevitable while requiring professionals to remain answerable for their conduct and organisations to investigate the conditions that contributed to failures. The traditional assumption that adequately trained, conscientious professionals should be able to avoid all errors is, she argued, counterproductive.
When patients are harmed, investigators should ask whether known risks were reported and addressed, whether adequate safeguards existed, and whether the organisation’s systems allowed an error to reach the patient.
“Accountability must lead to corrective action and learning”, including identifying root causes, strengthening safeguards and monitoring whether interventions prevent a recurrence, she asserted.
Reporting incidents, near-misses, complaints and adverse patient experiences is therefore only the beginning. Information must be verified, risks prioritised, responsibility assigned and action followed up. Poor incident recording can also create a dangerous blind spot: the absence of an entry in a register cannot be taken as evidence that an adverse event never occurred.
Mndaweni called for more proactive risk management, using incident reports, audits and early-warning indicators to identify vulnerabilities before patients are harmed.
Technology creates new accountability questions
The growing use of artificial intelligence, digital clinical decision-support systems, electronic prescribing and automated diagnostic systems adds another layer of complexity.
Technology does not remove human responsibility, she warned. When its application contributes to harm, accountability may involve the clinician, healthcare establishment, institutional governance structures, system administrators, technology developers or several parties simultaneously. The answer lies in clearly defined responsibilities and safeguards, rather than assuming that introducing technology automatically makes healthcare safer.
Mndaweni stressed the importance of clinical guidelines and standardised protocols in reducing unjustifiable variations in care. But the existence of a policy does not demonstrate that it is being implemented.
The OHSC was reviewing the country’s norms and standards through a multi-stakeholder process involving the public and private sectors. She said that the regulator wants to advance beyond structural requirements towards more comprehensive measures of clinical processes and patient outcomes.
Structural standards establish the essential inputs for safe care, including infrastructure and equipment. Process standards examine what healthcare workers and institutions actually do, while outcome standards assess the results for patients. All three are necessary, she argued, and patients must be involved in discussions about which clinical outcomes should be measured. Patient experience and complaints must likewise inform service improvements. Patients should be partners in decisions about their care, rather than passive recipients within a hierarchical system in which questioning a healthcare professional can be difficult.
Complaints are rising
The Health Ombud, operating within the OHSC’s regulatory framework, provides an independent mechanism to investigate complaints concerning non-compliance with prescribed standards. It can examine individual and systemic failures, identify recurring problems, recommend improvements and monitor implementation.
The number of complaints received by the Health Ombud rose sharply over the past two fiscal years, Mndaweni’s revealed. Cases increased from 2 389 in 2023/24 to 3 810 in 2024/25 and 4 159 in 2025/26, following declines in the preceding two years.
For patients and the state alike, the ultimate test of accountability is not whether an incident has been documented or a responsible individual identified, but whether the underlying failure has been corrected and the risk of further harm reduced, she concluded.