NHS chief executive Sir David Nicholson has spelled out his determination to carry on leading the health service as he faced a grilling from MPs over his role in the Stafford Hospital scandal.
There has been calls for Sir David's resignation over the failings, which led to hundreds of needless deaths.
He was head of the health authority for 10 months that oversaw the hospital.
Appearing before the Health Select Committee, he admitted to faults but said he would not be stepping down.
He confessed patients had not always been put first by the system.
But Sir David said the current reorganisation under the government's NHS reforms meant it was a period of "maximum risk" and he had promised the health service and ministers he would see through the changes.
Forty MPs have signed an early day motion calling for a his resignation.
Sir David's appearance before MPs comes a month after the publication of the final report of the public inquiry into the scandal, which saw hundreds of patients die after neglect and abuse from staff.
The report said primary responsibility for the scandal lay with the board of the hospital, but also that the whole system had failed by putting corporate self-interest ahead of patients.
During the televised hearing, committee member Valerie Vaz told him he seemed to be a "process man" who was not focused on quality of care.
Sir David rejected this description as "unfair".
'Maximum risk'Ms Vaz and other members of the committee then went on to quiz Sir David about his leadership of the local health authority that oversaw Stafford Hospital.
He was in post for 10 months between 2005 and 2006 at the height of the failings in care before climbing up the NHS hierarchy to take the top job.
Sir David told the committee: "During that period, across the NHS as a whole, patients were not the centre of the way the system operated.
"For a whole variety of reasons, not because people were bad but because there were a whole set of changes going on and a whole set of things we were being held accountable for from the centre, which created an environment where the leadership of the NHS lost its focus.
"I put my hands up to that and I was a part of that, but my learning from that was to make sure it doesn't happen again."
He then went on to spell out the key issues health authorities were focusing on - access targets, such as the A&E four-hour waiting time target, and hospital infections, such as MRSA, and the reorganisation of structures.
"That was narrow, and I accept that that was a narrow definition of accountability, but that was the way it worked," Sir David told the committee.
"It shows in Mid-Staffordshire, that that was a big failing in the whole system and I was in that system and I was part of it, absolutely."
David Cameron has made it clear in recent week's Sir David has his backing.
On Tuesday, the prime minister's official spokesman said Mr Cameron thought he had done "a very good job" as chief executive of the NHS and that he was "impressed with his knowledge and understanding of the NHS".
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