This article explores possible links between organizational publicness, goal ambiguity and patient safety. Despite organizational and management initiatives designed to improve matters, patient safety in hospitals remains a major challenge. Much research has focused on leadership and culture, which have been shown to be crucial factors in assuring patient safety. However, improvements have been slow in coming. There may be merit therefore in examining other factors that play a part in assuring safety, especially those that address the ambiguities inherent in health care organizations. Two such factors that have received increasing attention from organization theorists are publicness and goal ambiguity. Publicness addresses the complexity now inherent in defining the public or private nature of health care organizations; goal ambiguity addresses the diversity of goals that organizations, especially public ones, are expected to fulfil. Both hinder improvements in patient safety; greater effort needs to be made to minimise the ambiguities involved.