At a crossroads? Key challenges and future opportunities for patient involvement in patient safety

In 2002, Charles Vincent and Angela Coulter published what would become a seminal paper in the field of patient safety.1 Their argument was simple and compelling—that patient safety could be improved through the greater involvement of patients and their families. Over the past decade, the healthcare landscape has evolved, with patients and families now firmly placed at the centre of care design and delivery in both policy, and increasingly practice. However, as highlighted in two papers2 ,3 published in this issue of BMJ Quality & Safety, there remain significant challenges in the meaningful integration of the patient perspective in improving the safety of care. Why does involving patients in safety improvement remain so hard? In this editorial, we propose a number of reasons, before considering some potential future opportunities for improving the involvement of patients and their families.