Measuring patient safety for individual hospitals and health systems remains a challenge. Incident reports provide one lens into patient safety, despite concerns about under-reporting. Numerous incident reports may indicate either a high number of errors or a robust safety culture that encourages blame-free event reporting. Therefore, it is unclear whether the volume of incident reports should serve as a patient safety metric. In this study, investigators analyzed all incident reports from the national reporting system in the United Kingdom and determined that hospitals with fewer litigation claims had more incident reports. They found no association between mortality or patient satisfaction and number of reports, and more incident reporting took place where survey results indicated a positive safety culture. These findings suggest that having a high quantity of incident reports does not signify an error-prone environment, and the authors recommend against using incident reporting rates as a quality metric. A past PSNet perspective discussed incident reporting systems as tools for improving patient safety.