What Clinical Accountability Actually Means
Clinical Product roles often come with a single, heavy line in the job description: accountable for clinical safety.
It sounds clear, but there's a gap: organisations know they need someone accountable for clinical safety, they just don't realise what that person needs to do it well - or they're not willing to give it. That gap is where most of the difficulty lives.
What you're actually accountable for
When you own clinical accountability, you're responsible for ensuring that what ships is safe, appropriate, and defensible from a clinical perspective.
That covers:
- Clinical accuracy - the product reflects sound clinical reasoning
- Safety - the product doesn't expose users to unacceptable harm
- Appropriateness - the product behaves correctly for the clinical context
- Auditability - decisions can be traced and justified
None of these are binary. All of them involve judgement. And all of them require someone (i.e. the Clinical Product Manager) to make the call.
What that responsibility looks like
You own the clinical call.
Other people might review clinical content. Engineers might flag edge cases. Product Managers might push back on constraints. But the final clinical judgement - whether this is safe, appropriate, and defensible - is yours. You can seek input, but you can't delegate the decision.
You shape what's possible from the start.
If you're brought in too late to influence a feature's direction, and it ships with a clinical flaw, you still carry responsibility for that gap. This is why being embedded matters - your responsibility doesn't start at sign-off, it starts at discovery. Every time you approve something, block something, or shape a requirement, you're defining the bounds of what the team can build next.
You must be able to defend the reasoning.
If something goes wrong - or if someone asks why a decision was made - you need to be able to explain it. "I thought it was fine" isn't a defence. "Here's the clinical reasoning, here's what we knew, here's what we weighed up, here's why we judged it acceptable" is.
Responsibility vs accountability
If you're solo, you also carry the accountability.
In a mature Clinical Product function, you are responsible for making these calls but accountable to a Head of Clinical Product or similar title. They carry the organisational accountability - answering to leadership and regulators when things go wrong.
But if you're solo - the only clinical product person in the organisation - you carry both. That means when something ships with a clinical issue, the accountability lands with you. When a clinical incident happens, you're the one explaining what went wrong to the team, to leadership, to regulators if needed. When the company faces clinical risk exposure, it's your judgement under scrutiny.
This is the reality for many Clinical Product Managers right now. It's also why being solo in this role is so difficult.
The weight of it
This is the part that doesn't fit neatly into a job description.
Clinical accountability is heavy. You're making decisions that affect patients at scale - a single call can impact thousands. Often with incomplete information. Often under time pressure. Often with people waiting for you to say yes.
You will get things wrong. As a junior, you'll get stung because you don't know what you don't know - and that's where a supportive, experienced team comes in (more on that in a later post). But even as a competent Clinical Product Manager, you'll still get things wrong. That's because judgement under uncertainty means some calls won't land perfectly.
The question isn't whether you'll make mistakes. It's whether your mistakes are defensible. It's the same as any other clinical practice - would a reasonable person, with the same information, have made the same call?
A practical framing
A useful way to assess whether something is ready to ship is to pressure-test the decision against real-world scrutiny:
- Could the rationale stand up to regulatory review?
- Would the decision remain defensible if examined publicly?
- Would this feel reasonable to the patient affected by it?
If the answer to any of those is no, think twice about releasing.
This isn't about being perfect. It's about being honest - with yourself, with the team, and with the people who use the product. Commercial pressure and technical shortcuts are constant; the Clinical Product role exists to counterbalance them and act as the moral compass for safe healthtech.
What organisations get wrong
Many organisations assign accountability without giving the tools to exercise it.
I've seen clinicians asked to advise but not own outcomes; a single Clinical Product Manager spread thin across multiple teams; and clinical product embedded within a team but fundamentally misunderstood.
Having a Clinical Product role, or better yet, a function, is a significant first step. In practice, Clinical Product Managers are frequently:
- Lacking visibility into what is actually shipping
- Brought in too late to influence key decisions
- Given responsibility without the authority to block
- Overstretched, with scope that exceeds realistic capacity
This isn't sustainable. Clinical Product Managers need to be set up to succeed - with the right authority, the right visibility, and the right support. That starts with being honest about what the accountability actually entails.
This post is part of a series on what Clinical Product actually is. Subscribe to be notified of new posts.
