The National Quality Forum first defined a set of never events to highlight significant errors that should never occur. This list gained traction in 2007 when the Centers for Medicare & Medicaid Services announced that it wouldn’t pay for additional costs associated with these errors. This article provides a theoretical framework to understand which hospitals may engage in safety solutions, and whether these solutions are created within their structures or by using outside suppliers. Their findings suggest that hospitals with certain characteristics (e.g., larger, teaching, safety net, competitive) are more likely to engage in innovations, and that those reacting positively will internalize their innovations rather than approach the market. An accompanying editorial challenges the commentary’s assertions, suggesting their views may be too narrow or provide an incomplete perspective of strategic behavior and decision-making around patient safety.