This commentary broadly discusses the patient safety movement since the Institute of Medicine report and debates the role safety efforts should play in improving health care quality. The authors describe the notion of preventable deaths as a focus of ongoing safety interventions. By contrasting existing recommendations from players in the quality and safety movement (eg, AHRQ, JCAHO, Leapfrog), they illustrate the tension between implementing interventions that lack 'evidence' without delaying common-sense interventions that await formal evaluation. They advocate for consistent use of evidence-based research to disseminate quality improvement, greater adoption of safety efforts as a part of quality rather than a competitor of it, and ongoing appreciation of what outside industries can bring to health care innovations.