Healthcare has failed to make the same progress as other high-risk industries when it comes to creating safety – despite over a decade of research, education and implementation of safety systems in health services. Safe care is created by systems and standardization, and also by proactive, thinking staff working in partnership with consumers and each other; but the healthcare industry appears to struggle to reconcile these concepts. Even with our evolved knowledge of how human beings operate in organizations, and the best intentions, the dominant change paradigm in healthcare is still hierarchical, based on top-down policies implemented by managers and staff. Although the power spread in health services is being tested through generational change, we have a long way to go before proactivity and initiative at the front line are universally fostered and welcomed by healthcare managers and senior clinicians. "Front Line Ownership: Generating a Cure Mindset for Patient Safety," by Zimmerman et al., presents a persuasive example of how staff ownership of improving consumer safety is a powerful tool for change, one that deserves its place at the front line of safety and quality improvement methods.