In a patient-centred health system the views, experiences and rights of the patient drive the way that care is delivered. There is now an increasing emphasis on patient-centredness as an essential characteristic of safe and high quality care, but to date the involvement of patients in patient safety activities has been limited. The views and priorities of patients are not always valued in safety and quality work, and their perspectives are rarely included in activities such as incident investigation. We propose six areas of action to make patient safety more patient centred and hypothesise that the replacement of industrial safety models with a patient-centred model of safety culture will improve clinicians' ability to engage with safety initiatives.