Medical errors occur frequently but there is great variability in whether they are reported. Focus groups and one-on-one interviews were used in this study to determine the effect of hospital culture and climate on employee decisions to speak up–or not–about medical errors. The authors conclude that their results, gathered from a large hospital in a mid-sized city in the midwestern U.S., indicate this hospital’s culture does not facilitate reporting of medical errors and suggest that creating a positive organizational culture can both promote speaking up about medical errors and increase patient safety.