Engaging patients in safety efforts is required as one of the National Patient Safety Goals, and is a key component of providing patient-centered care. This review examines ways in which patients have been integrated into clinical decision-making, discusses examples of patient involvement in reducing medication errors and encouraging hand hygiene, and proposes a framework for including patients in safety efforts. Although patient engagement has significantly improved safety efforts in some circumstances, surveys have shown that patients may be reluctant to engage in safety programs if they feel they are being asked to challenge their health care providers.