This study evaluated the role professionalism, regulation, and market forces played in shaping an organization's patient safety efforts. Investigators used 85 semistructured interviews with hospital leaders (part of a larger hospital tracking study) to determine current safety initiatives, factors facilitating or impeding safety progress, and the impact of these efforts on the hospital, providers, and patients. The authors discovered that major patient safety initiatives focus on complying with Joint Commission and Accreditation of Healthcare Organizations (JCAHO) requirements. As a result, Medicare served as an important facilitator of safety efforts due to the fact that hospitals must receive JCAHO accreditation to receive reimbursement for this patient population. On the other hand, barriers identified included the lack of local market incentives and an information technology infrastructure. The authors propose a series of policy-level recommendations to strengthen the business case for necessary efforts. Two past studies similarly discussed the business case for quality and safety.