Understanding the key factors underlying safety culture remains critical to improvement efforts. This cross-sectional study examined whether openness was associated with in-hospital mortality in the English National Health Service. Investigators measured openness with a composite measure derived from four questions from a staff survey: comfort with speaking up about safety concerns, disclosure of safety problems to staff, knowledge of reporting practices, and perceived security in reporting safety concerns. After adjustment for hospital size, the authors found that increased openness was associated with lower mortality. This relationship suggests that openness constitutes an important aspect of a positive safety culture. The results lend weight to calls for increased transparency in health systems. A past PSNet perspective discussed the evolution of patient safety and traced its development and progress in the United Kingdom.