Advances in patient safety require a receptive culture that values transparency, communication, and mutual respect. The Safety Attitude Questionnaire is an effective tool that can be used to assess the safety culture in a variety of clinical settings. Transformational leadership is essential in promoting a culture of safety. There are several strategies available to these leaders that will improve patient safety including Patient Safety Leadership Walkrounds, briefings, huddles, debriefings, and conflict resolution. Finally, leaders must maintain a “just culture” that recognizes most errors involve system deficiencies not human error and that disruptive behavior cannot be tolerated.