The hidden curriculum, disruptive behaviors, and hierarchy can influence health care workers' willingness to speak up about safety hazards. This study examined psychological safety, or the extent to which health care workers feel comfortable speaking up about patient safety. A substantial minority of employees stated that they would not report an error, most often due to fear of retaliation. As with prior studies of safety culture, workers with supervisory roles reported more positive feelings than frontline staff. These results underscore the need to implement a blame-free culture in order to promote patient safety. A past AHRQ WebM&M commentary discussed strategies to reduce disruptive behaviors and to enhance communication between nurses and physicians.