In their study on the current state of the quality agenda in the Canadian healthcare system, Sullivan and colleagues interviewed healthcare leaders across Canada who predominantly represent the hospital care sector. The home and community sector is under-represented in research and discussions about quality and patient safety, despite the fact that it is the fastest-growing sector in healthcare. Patient safety research in home care has been spearheaded by VON Canada and the Canadian Patient Safety Institute since 2005. Quality and safety are not just parallel imperatives; rather, they are inextricably linked concepts that rely on each other to function effectively. Safety for clients or patients is complex when multiple organizations, regulated and unregulated paid providers and unpaid family caregivers make up the team providing care in an uncontrolled home environment. Add to this the pressure of reducing costs while increasing home care admissions, and the equation seems impossible. Client or patient participation is increasingly recognized and advocated as a main component in the redesign of healthcare processes to improve patient safety and may provide a key organizing principle for better care and outcomes.