Maybe part of the issue is that ( in Europe and the USA) we've pushed accountability and responsibility further and further down the food chain and given the job of policing that to the bureaucrats at the top, who ought to be the ones held accountable.
So nurses, doctors, teachers, (maybe even patent officers), etc. have to be so accountable that they spend their lives drowning in paperwork and never know when the rules will change on the whim of a higher up. And will be to blame when something goes wrong. But the higher-ups can do pretty much what they like, as long as they can show that they are in line with their masters' political agendas and be safe to enjoy their nice secure niche for as long as they want.