A 2009 Joint Commission sentinel event alert highlighted the importance of committed organizational leadership in improving safety. However, what remains unclear is how leadership engagement in safety and quality can be measured and compared across organizations. This study reports on the development of a novel instrument, the Hospital Leadership and Quality Assessment Tool (HLQAT), which measures organizational commitment to safety and quality across six key domains (which include leadership commitment and accountability, appropriate organizational structures, and adaptive capability). The HLQAT proved to have excellent reliability, and a moderately strong correlation was found between higher HLQAT scores and better performance on publicly reported quality metrics. As widely promoted tools for leadership engagement—such as executive walkrounds—have recently been shown to have disappointing real-world performance, tools like the HLQAT may prove useful in objectively measuring leadership's true commitment to safety.