An important element of providing patient-centered care, active patient engagement is also a potential strategy to promote safety. Efforts to understand the patient's role in safety continue, despite concerns about shifting such responsibility to patients. This qualitative study explored patient and family members' perceptions about safety after recent encounters with the health care system. Investigators found that patients identified many safety concerns during their care experience. Patients' ability to speak up was influenced by the threat of harm, the relative importance of their concern given other patients' needs and staff workloads, and the consequences of speaking up. Those who did speak up reported varied responses from providers, including welcome reassurance and exacerbated anxieties. The authors advocate for “listen up” campaigns directed at providers that mirror Speak Up patient-driven campaigns.