The evaluation methodology shows a critical need for robust translational research and innovation in radiologic informatics within Sub-Saharan Africa. This scenario is professionally challenging because it requires balancing the potential benefits of new technologies and data-driven insights with the unique infrastructural, ethical, and regulatory landscapes present in diverse African healthcare systems. Ensuring patient privacy, data security, and equitable access to advanced informatics solutions while fostering innovation demands careful consideration of local contexts and adherence to emerging regional guidelines. The best approach involves establishing a collaborative framework for translational research that prioritizes patient consent and data anonymization, aligning with principles of ethical research conduct and data protection regulations prevalent across many African nations, such as those influenced by the African Union Convention on Cyber Security and Personal Data Protection. This approach ensures that innovation is pursued responsibly, with a clear understanding of data governance and the potential impact on vulnerable populations. By focusing on anonymized data and robust consent mechanisms, it upholds patient autonomy and confidentiality, which are fundamental ethical and often legally mandated requirements. Furthermore, this method directly supports the development of registries that can inform future research and quality improvement initiatives without compromising individual privacy. An approach that focuses solely on technological advancement without adequately addressing data governance and patient consent is professionally unacceptable. This failure to prioritize ethical data handling and patient rights can lead to breaches of privacy, erosion of public trust, and potential legal repercussions under data protection laws. Similarly, an approach that relies on retrospective data analysis without explicit consent for research purposes, even if anonymized, risks violating ethical principles and potentially contravening regulations that require informed consent for the secondary use of health data. Finally, an approach that seeks to implement innovations without engaging local stakeholders and understanding their specific needs and challenges neglects the crucial aspect of contextual relevance and sustainability, potentially leading to the adoption of solutions that are not fit for purpose and do not benefit the intended recipients. Professionals should employ a decision-making process that begins with a thorough understanding of the local regulatory and ethical landscape. This involves identifying relevant data protection laws, ethical review board requirements, and any regional guidelines pertaining to health informatics and research. Subsequently, they should assess the potential benefits and risks of any proposed innovation, with a particular focus on patient privacy, data security, and equity of access. Engaging with local stakeholders, including clinicians, patients, and policymakers, is paramount to ensure that research and innovation are contextually appropriate and sustainable. Prioritizing patient consent and robust data anonymization techniques should be a non-negotiable starting point for any translational research or registry development in radiologic informatics.

The evaluation methodology shows that ensuring the quality and safety of radiologic informatics across Sub-Saharan Africa presents unique challenges. These include varying levels of technological infrastructure, diverse healthcare systems, and differing regulatory landscapes within the region. Professionals must navigate these complexities to implement and maintain high standards. Careful judgment is required to tailor quality and safety initiatives to local contexts while adhering to overarching principles. The most appropriate approach involves a comprehensive assessment of existing radiologic informatics systems, focusing on their alignment with established quality and safety frameworks relevant to the Sub-Saharan African context. This includes evaluating data integrity, system security, workflow efficiency, and the training of personnel. The purpose of the Applied Sub-Saharan Africa Radiologic Informatics Quality and Safety Review is to identify areas for improvement, promote best practices, and ultimately enhance patient care through reliable and safe imaging information systems. Eligibility for such a review typically extends to healthcare institutions and imaging departments within Sub-Saharan Africa that utilize radiologic informatics systems and are committed to improving their quality and safety. This approach is correct because it directly addresses the core objectives of the review by systematically evaluating current practices against established benchmarks, thereby identifying specific needs and opportunities for enhancement within the unique regional context. It aligns with the ethical imperative to provide safe and effective patient care and the professional responsibility to maintain high standards in medical imaging. An approach that focuses solely on the acquisition of the latest radiologic informatics technology without a corresponding assessment of existing infrastructure, staff training, and workflow integration would be professionally unacceptable. This fails to address the fundamental purpose of the review, which is about quality and safety, not just technological advancement. It overlooks the practical realities of implementation and the potential for new technology to exacerbate existing issues if not properly integrated and supported. Another professionally unacceptable approach would be to conduct a review based on generic international standards without considering the specific socio-economic and healthcare system realities of Sub-Saharan Africa. While international standards provide a valuable baseline, their rigid application without adaptation can lead to impractical recommendations and a failure to achieve meaningful improvements. This approach neglects the crucial element of context-specific relevance, which is central to the effectiveness of any quality and safety initiative in a diverse region. Finally, an approach that prioritizes cost reduction above all else, potentially leading to compromises in data security, system reliability, or personnel training, would also be professionally unsound. While financial considerations are important, they must not supersede the primary objectives of patient safety and data integrity. This approach undermines the ethical obligation to provide quality care and risks compromising the very systems the review aims to improve. Professionals should adopt a decision-making framework that begins with a clear understanding of the review’s purpose and eligibility criteria. This involves a thorough needs assessment that considers the specific context of the healthcare facility or region. Subsequently, professionals should identify relevant quality and safety frameworks, adapting them where necessary to ensure applicability. The process should involve stakeholder engagement to foster buy-in and ensure practical implementation. Finally, continuous monitoring and evaluation are essential to ensure sustained improvements in radiologic informatics quality and safety.

This scenario is professionally challenging because it requires balancing the immediate need for improved diagnostic imaging services with the long-term implications of technology adoption, particularly concerning data security and patient privacy within the specific regulatory landscape of Sub-Saharan Africa. Careful judgment is required to ensure that any new system not only enhances diagnostic capabilities but also adheres to ethical principles and relevant data protection laws. The best professional approach involves a comprehensive assessment of the proposed Picture Archiving and Communication System (PACS) and Radiology Information System (RIS) integration, with a strong emphasis on data security and patient privacy protocols. This includes evaluating the vendor’s compliance with relevant Sub-Saharan African data protection regulations, such as those that may exist in specific countries regarding the transfer and storage of sensitive health information, and ensuring robust encryption, access controls, and audit trails are in place. Furthermore, it necessitates a thorough risk assessment to identify potential vulnerabilities and the development of mitigation strategies aligned with established cybersecurity best practices and any applicable national health informatics standards. This approach prioritizes patient safety and trust by proactively addressing potential data breaches and ensuring compliance with legal and ethical obligations. An incorrect approach would be to prioritize cost savings and immediate implementation over thorough security and privacy vetting. This could involve selecting a vendor solely based on the lowest bid without adequately scrutinizing their data handling practices or their adherence to local data protection laws. Such a decision would be ethically unsound and could lead to significant regulatory penalties, reputational damage, and a breach of patient confidentiality, violating the fundamental duty of care owed to patients and potentially contravening national data protection legislation that mandates secure handling of personal health information. Another incorrect approach would be to proceed with integration without a clear understanding of the interoperability requirements and data governance policies. This might involve assuming that standard protocols are sufficient without verifying their compatibility with existing infrastructure or ensuring that clear guidelines are established for data ownership, access, and retention. This oversight could result in data silos, compromised data integrity, and difficulties in complying with audit requirements, thereby failing to establish a robust and accountable information system. A further incorrect approach would be to overlook the need for comprehensive staff training on the new system’s security features and data handling procedures. Even with the most secure system, human error can lead to breaches. Failing to adequately train personnel on privacy protocols, secure login practices, and the reporting of suspicious activities would create a significant vulnerability, potentially leading to unauthorized access or disclosure of patient information, which is a direct violation of ethical responsibilities and data protection mandates. Professionals should employ a decision-making framework that begins with identifying the core objectives of the technology adoption. This should be followed by a thorough review of the regulatory landscape, focusing on data protection, patient privacy, and health informatics standards relevant to the specific Sub-Saharan African context. A comprehensive risk assessment, including technical, operational, and legal considerations, should then be conducted. Vendor due diligence, focusing on their security certifications, compliance history, and data handling policies, is paramount. Finally, a phased implementation plan that includes robust testing, staff training, and ongoing monitoring and auditing will ensure that the adopted system meets both functional and ethical requirements.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between the need for timely patient care and the imperative to maintain the integrity and quality of medical imaging services. The radiographer is faced with a situation where a deviation from standard protocol might expedite a patient’s diagnostic process, but could also compromise the diagnostic accuracy and safety of the imaging. Balancing these competing demands requires careful judgment, adherence to established quality assurance frameworks, and a clear understanding of professional responsibilities within the Sub-Saharan African radiologic informatics context. Correct Approach Analysis: The best professional practice involves immediately escalating the situation to the supervising radiologist or lead radiographer. This approach is correct because it adheres to established quality assurance protocols and ensures that any deviation from standard imaging procedures is reviewed and approved by a qualified medical professional. Sub-Saharan African regulatory frameworks, while varying by country, generally emphasize the importance of supervised practice, adherence to imaging protocols, and the ultimate responsibility of the radiologist for diagnostic interpretation. This escalation ensures that patient safety and diagnostic accuracy are prioritized, and that any decision to alter standard procedures is made within a documented and approved framework, aligning with principles of good clinical governance and patient care. Incorrect Approaches Analysis: Proceeding with the modified imaging technique without consultation is professionally unacceptable because it bypasses essential quality control measures. This action directly violates the principle of supervised practice and can lead to inconsistent image quality, potentially inaccurate diagnoses, and a failure to meet the standards expected by regulatory bodies overseeing medical imaging in Sub-Saharan Africa. It also places the radiographer in a position of making critical clinical decisions beyond their defined scope of practice. Suggesting the patient undergo a less comprehensive scan to save time is also professionally unacceptable. This approach compromises the diagnostic intent of the examination, potentially leading to missed pathology and inadequate patient management. It prioritizes expediency over diagnostic completeness, which is a fundamental ethical and regulatory failure in medical imaging. Such a decision should only be made by a radiologist based on a comprehensive clinical assessment. Ignoring the discrepancy and proceeding with the standard protocol as if the issue did not arise is professionally unacceptable. While seemingly adhering to protocol, this approach fails to address a potential quality issue that could impact the diagnostic value of the image. It neglects the radiographer’s responsibility to ensure the quality of the images they produce and to report any factors that might compromise diagnostic interpretation, thereby failing to uphold the standards of radiologic informatics quality and safety. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety and diagnostic integrity. This involves: 1) Recognizing and identifying potential deviations from standard protocols or quality issues. 2) Consulting established institutional policies and regulatory guidelines for guidance. 3) Escalating concerns to the appropriate supervisory personnel (e.g., supervising radiologist, lead radiographer) for review and decision-making. 4) Documenting all actions taken and decisions made. This systematic approach ensures accountability, promotes continuous quality improvement, and upholds the highest standards of patient care within the specific regulatory landscape.

The audit findings indicate a potential discrepancy in how the radiologic informatics quality and safety review blueprint weighting and scoring are applied, leading to uncertainty about retake policies for individuals who do not meet the required standards. This scenario is professionally challenging because it requires balancing the need for consistent and fair application of quality standards with the practical realities of professional development and the potential impact on an individual’s career progression. Careful judgment is required to ensure that the blueprint accurately reflects essential competencies, that scoring is objective and transparent, and that retake policies are supportive rather than punitive, all while adhering to the established regulatory framework for radiologic informatics quality and safety in Sub-Saharan Africa. The approach that represents best professional practice involves a thorough review of the existing blueprint to ensure its alignment with current best practices in radiologic informatics quality and safety, followed by a transparent communication of any revised weighting or scoring mechanisms to all stakeholders. This revised blueprint should then be used to assess performance, and the retake policy should be clearly defined, offering constructive feedback and opportunities for remediation before a final assessment. This approach is correct because it prioritizes fairness, transparency, and professional development, aligning with the ethical imperative to maintain high standards of patient care through competent professionals. It also implicitly supports the spirit of continuous improvement inherent in quality and safety frameworks, ensuring that assessments are meaningful and contribute to enhanced practice rather than simply acting as gatekeeping mechanisms. An approach that focuses solely on increasing the difficulty of the blueprint or making retake opportunities scarce without clear justification or support mechanisms fails to uphold the principles of fairness and professional development. This would be ethically problematic as it could disproportionately penalize individuals without providing them with the necessary resources to succeed. Another incorrect approach would be to arbitrarily adjust scoring thresholds based on individual performance rather than adhering to pre-defined, objective criteria. This lack of standardization undermines the integrity of the review process and can lead to perceptions of bias, violating principles of equitable assessment. Furthermore, implementing a retake policy that imposes significant financial or professional penalties without offering clear pathways for improvement or remediation is ethically questionable and counterproductive to fostering a culture of quality and safety. Professionals should adopt a decision-making framework that begins with understanding the purpose and scope of the radiologic informatics quality and safety review. They should then critically evaluate the blueprint’s content and weighting to ensure it reflects essential knowledge and skills. Transparency in communication regarding scoring and retake policies is paramount. When discrepancies arise, the focus should be on identifying the root cause, whether it’s an issue with the blueprint, the scoring process, or the retake policy itself, and addressing it through a systematic and evidence-based approach that prioritizes fairness, professional growth, and ultimately, patient safety.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexities of advanced imaging modalities and the critical need to ensure patient safety and diagnostic accuracy within a resource-constrained environment. Balancing the adoption of new technologies with established quality assurance protocols, while also considering the practicalities of implementation and staff training, requires careful judgment. The potential for increased radiation dose with CT, artifacts with MRI, and operator dependency with ultrasound, coupled with the integration challenges of hybrid imaging, necessitates a robust and evidence-based approach to quality and safety. Correct Approach Analysis: The best professional practice involves a systematic, evidence-based approach to evaluating and integrating advanced modalities. This begins with a thorough review of the modality’s established performance metrics, including diagnostic accuracy, safety profiles (e.g., radiation dose for CT, magnetic field safety for MRI), and potential for artifacts. This review should be informed by current international best practices and guidelines relevant to radiologic informatics quality and safety. Subsequently, a pilot implementation phase, with rigorous quality control measures and staff training, is crucial before full integration. This phased approach allows for identification and mitigation of potential issues, ensuring that the modality is used safely and effectively, aligning with the principles of good clinical practice and patient care. Incorrect Approaches Analysis: Implementing a new advanced modality solely based on its perceived technological superiority or marketing claims, without a comprehensive review of its established performance metrics and safety profiles, is professionally unacceptable. This approach risks introducing unvalidated technologies that may not offer demonstrable clinical benefit or could even compromise patient safety due to unforeseen issues or inadequate understanding of its limitations. Adopting an advanced modality without adequate staff training and competency assessment is a significant ethical and regulatory failure. Radiologic technologists and interpreting physicians must be proficient in the operation, image acquisition, and interpretation specific to each modality to ensure diagnostic quality and patient safety. Lack of training can lead to suboptimal image quality, misdiagnosis, and potential patient harm. Integrating an advanced modality without establishing clear quality assurance protocols and performance monitoring mechanisms is also professionally unsound. Continuous quality improvement is a cornerstone of safe and effective medical imaging. Without established benchmarks and regular audits, it becomes impossible to identify and address deviations from expected performance, potentially leading to a decline in diagnostic accuracy and patient care over time. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes patient safety, diagnostic accuracy, and adherence to established quality standards. This involves: 1) Needs Assessment: Identifying clinical needs that advanced modalities can address. 2) Evidence Review: Thoroughly researching the modality’s performance, safety, and efficacy based on peer-reviewed literature and reputable guidelines. 3) Risk-Benefit Analysis: Evaluating potential benefits against risks, including cost, operational complexity, and patient safety concerns. 4) Pilot Testing and Validation: Implementing the modality in a controlled environment with rigorous quality checks. 5) Training and Competency: Ensuring all personnel are adequately trained and assessed. 6) Ongoing Monitoring and Improvement: Establishing continuous quality assurance processes.

Strategic planning requires careful consideration of candidate preparation resources and timeline recommendations for the Applied Sub-Saharan Africa Radiologic Informatics Quality and Safety Review. This scenario is professionally challenging because effective preparation directly impacts candidate success, the perceived value of the certification, and ultimately, the quality of radiologic informatics practice across the region. Inadequate resources or unrealistic timelines can lead to frustration, reduced participation, and a failure to achieve the review’s objectives of enhancing quality and safety. The best approach involves a comprehensive assessment of existing resources and a phased timeline that balances thoroughness with accessibility. This includes identifying and curating a diverse range of high-quality, region-specific study materials, such as relevant national guidelines, case studies from Sub-Saharan African institutions, and foundational texts. Recommendations for a phased timeline should incorporate ample time for self-study, group discussions, and practice assessments, with clear milestones. This approach is correct because it aligns with the ethical obligation to provide candidates with a fair and equitable opportunity to succeed, ensuring they are adequately prepared to meet the standards of radiologic informatics quality and safety. It also supports the professional goal of raising the bar for practice across the region by equipping professionals with the necessary knowledge and skills. An incorrect approach would be to rely solely on generic, internationally sourced materials without adaptation to the Sub-Saharan African context. This fails to address the unique challenges, technological landscapes, and regulatory environments present in the region, potentially leading to a disconnect between study materials and examination content. Ethically, this is problematic as it does not provide candidates with the most relevant and applicable preparation. Another incorrect approach is to recommend an overly compressed timeline, assuming candidates can quickly absorb complex information. This overlooks the demands of professional practice and the need for reflective learning. It creates an unfair advantage for those with more available time and can lead to superficial understanding rather than deep comprehension, undermining the review’s purpose. A further incorrect approach would be to provide a single, rigid study plan without offering flexibility or acknowledging different learning styles and paces. This fails to recognize the diverse backgrounds and professional commitments of candidates, potentially excluding or disadvantaging many. Professional decision-making in this context requires a commitment to inclusivity, relevance, and fairness, ensuring that preparation resources and timelines are designed to maximize the success and learning of all eligible candidates. Professionals should consider the practical realities of the target audience, the specific learning objectives of the review, and the ethical imperative to promote equitable access to knowledge and professional development.

The risk matrix shows a moderate likelihood of a moderate impact adverse event related to contrast media administration in a sub-Saharan African radiology department. This scenario is professionally challenging because it requires balancing the diagnostic benefits of contrast-enhanced imaging with the potential for patient harm, particularly in resource-limited settings where immediate access to advanced supportive care might be constrained. Careful judgment is required to implement appropriate safety protocols without unduly hindering necessary diagnostic procedures. The best approach involves a proactive, multi-faceted strategy that prioritizes patient safety through comprehensive pre-procedure assessment, standardized administration protocols, and robust post-procedure monitoring, all within the context of available resources. This includes thorough patient screening for contraindications and allergies, ensuring appropriate hydration, administering contrast at the lowest effective dose and rate, and having clear protocols for managing potential adverse reactions, including immediate access to emergency medications and trained personnel. This aligns with ethical principles of beneficence and non-maleficence, and implicitly with quality and safety guidelines that emphasize risk mitigation and patient well-being, even in settings with limited infrastructure. An incorrect approach would be to rely solely on post-procedure observation without adequate pre-procedure screening or standardized administration guidelines. This fails to proactively identify at-risk patients and increases the likelihood of an adverse event occurring due to unaddressed pre-existing conditions or improper administration techniques. It neglects the ethical duty to prevent harm and may fall short of implicit quality standards that advocate for preventative measures. Another incorrect approach would be to over-emphasize the rarity of severe adverse events and therefore implement minimal safety checks, focusing only on immediate emergency response. This disregards the potential for cumulative harm and the importance of a systematic approach to safety. While emergency response is crucial, it should be the last line of defense, not the primary safety strategy, and this approach fails to uphold the principle of due diligence in patient care. A further incorrect approach would be to adopt protocols identical to those in high-resource settings without considering local feasibility and resource availability, leading to impractical or unachievable safety measures. This can create a false sense of security while failing to address the actual risks within the local context, potentially leading to non-compliance and ultimately compromising patient safety. It demonstrates a lack of contextual understanding and fails to adapt best practices to local realities. Professionals should employ a decision-making framework that begins with a thorough risk assessment, considering the specific patient, the procedure, the contrast agent, and the local environment. This should be followed by the development and implementation of evidence-based, contextually appropriate safety protocols that encompass pre-procedure, intra-procedure, and post-procedure phases. Continuous training, regular review of adverse events, and adaptation of protocols based on experience and emerging evidence are essential components of a robust quality and safety management system.

This scenario presents a professional challenge due to the inherent risks associated with radiation exposure in diagnostic imaging and the critical need to maintain high-quality diagnostic information for patient care. Balancing the demands of efficient workflow with rigorous quality assurance protocols requires careful judgment. The regulatory framework in Sub-Saharan Africa, while varying by country, generally emphasizes patient safety, radiation protection, and the maintenance of diagnostic image quality through established quality assurance programs. The best approach involves a systematic and documented process for identifying and addressing image quality issues directly related to instrumentation. This includes establishing clear performance metrics for imaging equipment, conducting regular objective assessments of these metrics, and implementing corrective actions when deviations occur. This aligns with the principles of radiation protection and quality assurance mandated by regulatory bodies, which require healthcare facilities to ensure that imaging equipment functions optimally to minimize unnecessary radiation dose and maximize diagnostic accuracy. Proactive identification and resolution of equipment-related issues prevent the generation of suboptimal images, thereby avoiding repeat exposures and ensuring that clinicians receive reliable diagnostic information. An incorrect approach would be to attribute image quality degradation solely to operator technique without a thorough investigation of the imaging equipment. This fails to acknowledge the significant impact of instrumentation on image quality and can lead to misdirected training efforts and continued suboptimal imaging. It also bypasses the regulatory requirement for facilities to maintain their equipment in good working order. Another incorrect approach is to rely solely on subjective feedback from radiologists without implementing objective, quantitative quality control measures for the imaging equipment. While radiologist feedback is valuable, it is not a substitute for the systematic, evidence-based assessments required by quality assurance standards. This approach risks overlooking subtle but significant equipment performance degradations that may not be immediately apparent in every study but contribute to cumulative issues. Finally, an incorrect approach would be to delay corrective actions for identified equipment issues until they significantly impact patient care or lead to a formal complaint. Regulatory guidelines and ethical practice demand prompt attention to potential quality and safety concerns. Postponing necessary maintenance or calibration of imaging equipment not only compromises diagnostic accuracy but also exposes patients to potentially higher radiation doses than necessary, violating fundamental principles of radiation safety. Professionals should employ a decision-making framework that prioritizes a systematic, evidence-based approach to quality assurance. This involves establishing clear protocols for equipment performance monitoring, regular objective testing, prompt investigation of any identified deviations, and documented corrective actions. This framework ensures compliance with regulatory requirements, upholds ethical obligations to patient safety and diagnostic accuracy, and fosters a culture of continuous improvement in radiologic services.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for diagnostic information with the long-term implications of data integrity and patient safety. Radiologic technologists are entrusted with patient care and the accurate recording of medical information. Failure to adhere to established protocols, even under pressure, can lead to diagnostic errors, compromised patient care, and potential legal or professional repercussions. The pressure to expedite services must not override fundamental quality and safety standards. Correct Approach Analysis: The best professional practice involves meticulously documenting the discrepancy and immediately escalating it through the established reporting channels within the institution. This approach ensures that the issue is formally recognized, investigated, and addressed by the appropriate personnel. Adherence to institutional policies for reporting errors or discrepancies is paramount. This aligns with the principles of radiologic informatics quality and safety, which emphasize accurate data capture, error identification, and continuous improvement. Regulatory frameworks governing healthcare informatics and professional conduct for radiologic technologists mandate transparent reporting of deviations from standard procedures to maintain data integrity and patient safety. Incorrect Approaches Analysis: One incorrect approach involves overlooking the discrepancy and proceeding with the examination as if no issue occurred. This is ethically and professionally unacceptable as it directly compromises the integrity of the patient’s medical record and can lead to misdiagnosis or inappropriate treatment based on inaccurate information. It violates the professional duty to ensure the accuracy and completeness of diagnostic data. Another incorrect approach is to attempt to correct the discrepancy without proper authorization or documentation. This bypasses established quality control mechanisms and can introduce further errors or mask the original problem, making it difficult to identify the root cause. It undermines the systematic processes designed to ensure radiologic informatics quality and safety. A third incorrect approach is to discuss the discrepancy informally with colleagues without initiating a formal report. While collegial discussion can be helpful, it does not fulfill the professional obligation to formally document and report the issue. This failure to follow established reporting procedures prevents the necessary investigation and corrective actions, leaving the system vulnerable to repeated errors. Professional Reasoning: Professionals should employ a systematic decision-making process that prioritizes patient safety and data integrity. This involves: 1) Recognizing and understanding the discrepancy. 2) Consulting institutional policies and professional guidelines for reporting such issues. 3) Documenting the discrepancy accurately and comprehensively. 4) Escalating the issue through the designated reporting channels. 5) Following up to ensure the issue is addressed. This structured approach ensures accountability and promotes a culture of quality and safety.