What lessons from anesthesia are relevant to our broader efforts to improve overall patient safety?1,28,29 First, safety requires strong leadership, with a commitment to openness and a willingness to embrace change. Second, learning from past mistakes is an essential part of patient safety. In the case of anesthesia, the closed-case reviews led to key insights. Third, although technology is not the complete answer to safety, it must be a part of the answer. In anesthesia, the thoughtful application of oximetry, capnography, and automated blood pressure monitoring has been vital. Fourth, where applicable, the use of human factors engineering and forcing functions can markedly enhance safety (Chapter 7). For example, changing the anesthesia tubing so that the incorrect gasses could not be hooked up was crucial; this was a far more effective maneuver than trying to educate or remind anesthesiologists about the possibility of mix-ups. Finally, anesthesia was in the throes of a malpractice crisis and had a number of highly visible errors reported in the media. Sparks like these are often necessary to disrupt the inertia and denial that can undermine so many safety efforts. In the 1980s, anesthesiologists paid exorbitant rates for malpractice insurance—among the highest in the medical profession. Now that errors causing patient harm are so unusual, today's rates fall in the midrange of all specialties, a good example of the “business case for safety.”