While the costs of medical error to patients are well appreciated, the direct costs to institutions, especially if error does not result in litigation, are less so. Even when errors increase length of stay or require additional interventions, these events usually represent billable charges and are not, from a purely economic standpoint, injurious to the institution. The authors, while acknowledging the ethical and societal imperatives to improve safety, outline the “business case” for patient safety investment, arguing that the long-term benefits to an organization’s reputation, efficiency, and medico-legal defensibility compensate for the sometimes high up-front costs of implementation.