Patient involvement in patient safety is emerging as an area of growing policy, practice, and academic interest. In this article, we review the existing literature on patient involvement and patient safety and seek to highlight some of the key areas of challenge in this emergent field by relating it to themes identified in the wider, more mature, literature on patient and public involvement in health care in general. Insights from the wider literature illuminate key issues for involvement in patient safety and suggest promising ways of circumventing these challenges and achieving involvement in patient safety in a way that maximizes impact while avoiding unintended consequences.