The systems approach to analyzing medical errors holds that faulty systems, not irresponsible clinicians, are to blame for most preventable adverse events. That notwithstanding, individuals certainly bear some responsibility in most cases of errors, and a vigorous debate continues around the level of accountability required of clinicians and the consequences clinicians involved in errors should face. This review advances the concept of collective accountability—accountability at the level of the individual clinician, the health care team, and the institution—as a way to balance the distinction between systems issues and personal responsibility. Using an example case of a diagnostic error, the authors discuss how collective accountability would require clinicians and institutions to emphasize transparency in error disclosure and focus on optimizing team and system performance.