Abstract: The paper focuses on the need for transformational change to enhance patient safety and examines lessons learned as found in the management and transformational change literature-a literature that may be new to patient safety researchers, administrators, and care providers. Transformational change is a daunting undertaking as many chief executive officers have found as they try to revitalize and transform their organizations to a rapidly changing global marketplace. Significant transformational change also is needed in health care. The paper explores what transformational change means with respect to patient safety and quality initiatives. It draws on the transformational change literature to help identify the distinguishing features of successful transformations and provides emerging findings and examples in health care that illustrate transformational concepts in practice.