This article reviews the current status of patient safety efforts at academic medical centers (AMCs). Despite the leading role that many AMCs have assumed in safety and quality research, evidence indicates that patients cared for at AMCs are not safer than those hospitalized elsewhere. The authors discuss the unique aspects of AMCs that may hinder patient safety and quality improvement efforts, discuss methods for overcoming these barriers, and advocate for culture change within AMCs to promote patient safety programs. A prior study examined the culture of safety within an AMC and used findings to guide patient safety improvement efforts.