Nearly 20 years after the Institute of Medicine brought public attention to the issue of medical errors and adverse events, patient safety concerns remain a serious public health issue that must be tackled with a more pervasive response. This report, from the National Patient Safety Foundation, assesses the state of the patient safety field and sets the stage for the next 15 years of work. The report calls for the establishment of a total systems approach and a culture of safety, and calls for action by government, regulators, health professionals, and others to place higher priority on patient safety science and implementation.