Dedicated patient safety specialists support organizational safety systems and safety culture. In 2019, the English National Health Service (NHS) asked each NHS organization to identify at least one senior-level patient safety specialist. In this study, current patient safety specialists participated in interviews and/or responded to a survey regarding implementation and enactment of the role. Respondents reported experiencing varied levels of organizational support and highlighted tensions between a focus on strategic goals and maintaining an understanding of "work as done.”