Simulation has been used to improve patient safety in multiple settings. This study examines how simulation can enhance safety leadership. Executive leaders in health care organizations were given the simulated task of addressing patient safety failures, with the goal of improving participants' competency in transparency and safety culture. Qualitative analysis demonstrated widely diverging participant responses. There was a lack of leadership engagement with frontline staff around safety. Participants cited leadership walk rounds and committee participation as possible leadership involvement mechanisms. The authors also noted that participants did not consistently engage patients in their safety strategies. Simulation appears to be a promising leadership education strategy that may uncover gaps in current leadership practices. A PSNet perspective explored how leaders can promote cultural changes to improve patient safety.