Patient safety is currently a central issue in health care. Many principles of patient safety, such as a safety management system, have been copied from high-risk industries. However, without a fundamental understanding of the differences between health care and industry, most incentives and instruments will translate into bureaucracy, control and repression. The necessary risk reduction for the patient can only be achieved through changes in the culture and hierarchical structure within the health care system. This requires breaking through professional and departmental barriers and reshaping the traditional hierarchy.