Most healthcare organizations are still striving to achieve high reliability, the ability to minimize adverse events while consistently providing high-quality care in the context of a rapidly changing environment. leaders at the sharp end are best positioned to identify hazardous situations and address system flaws. As the safety field has evolved, there is a growing recognition of the role that leadership plays in prioritizing safety, through actions such as establishing a culture of safety, responding to patient and staff concerns, supporting efforts to improve safety, and monitoring progress. Research using various methodologies has defined the relationship between leadership actions and patient safety and has begun to elucidate key organizational behaviors and structures that can promote (and hinder) safety efforts. H This shift in leadership philosophy requires a fundamental change in how leaders are identified, developed, and supported within the organization. As healthcare continues to evolve, it is imperative that leaders at all levels are equipped with the skills and knowledge to effectively identify and address safety concerns, engage in continuous improvement efforts, and foster a culture of open communication and collaboration. By embracing a distributed leadership model, healthcare organizations can tap into the collective expertise and experience of their workforce to drive meaningful and sustainable improvements in patient safety.