Accountability runs downward to the patient. This is emphasized in professional ethics. This is what common moral sense would also tell us, since they very rationale of health care is the help which people need for the health difficulties which they encounter in their lives. Downward accountability entails the empowerment of patients and clients and a partnership understanding of the professional-client relationship. It is downward accountability which informs such ethical imperatives as respect for confidentiality and informed consent.
Accountability also runs sideways to colleagues and other professionals.
One's professional responsibilities cannot be discharged without a cooperative attitude to one' s co-workers, and professionals must be ready to give an account to each in both a positive and negative sense. One obvious form which lateral accountability takes is self-regulation. In the UK nurses and midwives express their accountability to a large degree to an body of other nurses and midwives organised for the purpose. This is the UKCC which, although set up by an Act of Parliament, wholly consists of people with experience in the professions. It does not take much thought to see that conflicts of accountability are possible, and in fact are quite common and pressing in our current health care system.