Dealing with the failure of many patient safety initiatives to positively impact patient safety is one of the most daunting issues healthcare systems now face. The concept of front-line ownership (FLO) and the research documenting the success of this approach is thus critical to all involved in the effort to make healthcare safer for patients. Focusing on why it is so important to involve front-line workers at every level in designing, implementing and evaluating patient safety initiatives is the subject of this commentary and, in the author's view, the only way to move from theory to practice, and from exhortation to the kinds of changes in behaviour and attitudes upon which patient safety depends.