Health care has historically treated data as something to be safeguarded rather than openly discussed. Even in the information age it is difficult for patients to access their own medical records and for clinicians to obtain data on their own clinical performance, and efforts to encourage public reporting of safety and quality data remain controversial. This report by the Lucian Leape Institute of the National Patient Safety Foundation strongly advocates for improving transparency in health care. The authors identify four key domains of transparency and ways in which they could be enhanced: transparency between clinicians and patients (by promoting error disclosure), transparency among clinicians themselves (through peer review processes), transparency of health care organizations with one another (using collaborative approaches to improving care), and transparency with the public (by publicly reporting quality and safety data). The report includes a series of specific recommendations for clinicians, health care organizations, and governmental and nongovernmental leadership to enhance transparency. The authors acknowledge that a robust culture of safety is essential in order to overcome barriers to the free flow of information. Prior reports from the Lucian Leape Institute have addressed the role of quality and safety in health professions education and the role of information technology in patient safety.