Abstract
The title of this article was a sign on President Harry Truman's desk in 1945. Truman knew very well that with authority comes great responsibility. Leaders for ages have known that the ultimate responsibility for their organization stops at their desk. Leaders, managers, or supervisors of an air medical operation can have all the superficial trappings of a safety management system yet still be at risk for catastrophic failures if the organization's leadership culture has tragic flaws. BP and Toyota may be prime examples of organizational failures and misplaced priorities, as evidenced by the high-profile failures of their quality control and safety systems. Theoretically, those corporations had systems in place to prevent either quality control of safety issues but broke down seemingly by failing to listen to those small but critically important voices screaming for attention within the organization.
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