The patient safety movement was born with the 1999 publication of the seminal To Err Is Human report by the Institute of Medicine (IOM). The subsequent decade has witnessed significant progress in improving safety through more robust accreditation and reporting requirements for specific safety problems, engagement of national organizations and leadership, and more sophisticated research, according to this commentary by Dr. Robert Wachter, a noted leader in the safety field. However, progress in several areas remains slow, such as uptake of health information technology and development of a safety culture that appropriately balances "no blame" with accountability. Overall, Wachter gives the safety movement a "B–" grade, compared to the "C+" awarded 5 years ago. The 10th anniversary of the IOM report has prompted several assessments of the state of the field, including a plenary session with many influential safety leaders at the 2009 National Patient Safety Congress that is available on video.