Prioritizing patient safety can be challenging for health system leadership. This qualitative study included interviews, extensive ethnographic observation, and review of documents to examine how three distinct hospitals conceived of and acted to improve patient safety. Researchers found that crises in the area of patient safety catalyzed activities in this area. They also highlight how differing perspectives on safety shaped organizational responses to crises. The authors conclude that shaping an understanding of patient safety issues as shared problems amenable to organization solutions is critical to improvement. A PSNet interview with senior author Mary Dixon-Woods expanded on the need to shape culture to foster improvement.