Patient safety walkrounds, in which senior hospital leaders meet with frontline staff to review patient safety concerns, has been promoted as a strategy to improve safety culture. Investigators interviewed senior leaders and frontline staff at two institutions with such walkrounds in place. While senior leaders espoused key principles such as an open, blame-free culture and frontline staff engagement, they also discounted issues raised by frontline staff and reported executive visibility as a goal of walkrounds. In turn, staff described disillusionment with the lack of follow-up on their concerns. These findings spotlight the challenge of implementing interventions intended to bolster safety culture more broadly, as discussed in a previous AHRQ WebM&M perspective.