Patient safety in Canada has improved. Yet, dramatic transformation in safety across the continuum of care remains elusive. Front-line ownership (FLO) as outlined by Zimmerman and colleagues represents a novel bottom-up, or "discovery," approach to surmounting the challenges of further improving patient safety. Zimmerman et al.'s rationale and pilot study results suggest, however, that answers to important questions are required prior to the general adoption of FLO. For instance, in FLO's front-line collaborations, what is senior leadership's role? Is it limited to support, or is there a critical role in setting priorities and networking outside organizational boundaries to avoid reinventing the wheel? Who is included in the FLO team? Are housekeepers, doctors and patients all key teammates and contributors to success? In the near term, health organizations' support for FLO should be balanced with more directive safety solutions, within a broad framework that values both evidence-based practice and the generation of practice-based evidence. In this context, the authors of this commentary probe particular dimensions of FLO's theory and practice to promote the best positioning of FLO to enhance its optimal application of knowledge to reduce harm and improve patient safety.

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