In this perspective, the author draws on analogies from aviation to frame the issues of patient safety and medical errors. Helmreich provides background on the methods and use of error data in aviation, and how those processes catalyzed improvements in safety practices and programs. Within that construct, the author discusses behaviors that put patients at risk, including communication and leadership failures, interpersonal conflicts, and ineffective preparation, planning, and attention to detail. The author explains the importance of accepting the inevitability of human error and understanding the importance of reliable data on error, both of which are necessary if providers are to systematically reduce the frequency and severity of adverse events. Incorporating lessons from aviation, such as focusing on teamwork and communication skills, Helmreich proposes a series of steps for creating error management programs. This article is from a British Medical Journal special issue on patient safety.