Zimmerman et al. have brought to light a number of issues that lead to a collective failure in healthcare safety culture, and propose how to overcome them. Front-line ownership (FLO) is a great success story in that respect, acknowledging that much of the problem and, therefore, solution, relates to how, not what, approaches and solutions have been implemented. In service of the healthy dialogue the authors have invited, this commentary suggests that there needs to be a purposeful shift in leadership, not only in the important area of patient safety but more generally throughout the health system. Three emerging perspectives around leadership are briefly introduced that provide some insight into FLO's success – complexity leadership, neuroleadership and phronetic leadership. Together, these reflect the importance of the underlying dynamics of how we could (re)frame our approaches to change, engage the right people in the right context and achieve sustainable solutions throughout the health system.

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