While acknowledging the need for committed leadership and improved financing, this commentary argues for greater attention toward compensation for victims of medical errors as a mechanism to make real progress in patient safety. The authors applaud the patient safety movement but discuss the tension between current tort liability reform and the dependence on transparency and a no-blame culture that must precede safety improvements. They propose an administrative model for compensation that addresses the need to generate accountability for errors with simultaneous promotion of reporting from providers. A strategy to develop a list of uniformly accepted "avoidable classes of events," such as paralysis following anesthesia, is offered as a method to rapidly identify claims that provide early compensation to patients and prevent providers from large pain-and-suffering awards. The details of such a system, the cost impact, and examples of how it might operationally function are presented.