Twenty years ago, Betsy Lehman, an award-winning health columnist for the Boston Globe, received a massive overdose of chemotherapy at one of the nation's most prestigious cancer hospitals. The discovery of these and other avoidable errors and adverse events was a wake-up call. During the 1990s, health care leaders and researchers began studying and documenting the scale of the safety problem in health care. However, urgent questions about patient safety remain unanswered. To begin to answer these questions, the Betsy Lehman Center for Patient Safety and Medical Error Reduction commissioned a RAND study about the landscape of patient safety in the Commonwealth of Massachusetts. RAND researchers interviewed expert observers (patients, health care leaders, academic experts, advocates, and others) about progress to date and future opportunities to produce safer patient care. These expert observers asserted that some progress has been made in Massachusetts but that it has mostly set the stage for the vital work that remains. Key areas for progress include standardization of care, improvements in communication across settings, reducing diagnostic error, and transferring the lessons learned in the hospital to other care settings. This report summarizes the results of the interviews and suggests several questions that could guide the design of an organized effort to improve patient safety in Massachusetts.