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A review of issues linking advocacy, patient safety, and quality.To heighten awareness of patient safety issues that require ongoing advocacy efforts by physicians treating spinal disorders.The 1999 Institute of Medicine report “To Err is Human. Building a Safer Health System” was a landmark publication that vaulted patient safety into the limelight of public awareness and media attention. The American Academy of Orthopedic Surgeons had addressed the wrong site surgery issue with its Sign Your Site Program even before the Institute of Medicine report. Several professional medical societies involved in spine care have made advocating for patient safety a priority.A summary of areas of advocacy efforts involving patient safety and quality. These include the Sign Your Site Program from the American Academy of Orthopedic Surgeons, Sign, Mark and X-ray from the North American Spine Society, Joint Commission on the Accreditation of Healthcare Organizations Universal Protocol, and technology assessment. Advocacy on the Federal, state, and local levels concerning patient safety is reviewed.Awareness of patient safety issues has increased. Several patient safety protocols (Sign Your Site, Sign, Mark and X-ray, and the Universal Protocol) are in place. There is increased monitoring of medical errors on the state and local, especially hospital, levels.Patient safety is an absolute provision of health care. Physicians need to set a personal example for compliance with existing patient safety systems such as the Universal Protocol and be active advocates for patient safety.