Executive walkrounds are widely used for improving safety culture, but their effect on specific patient safety attitudes and outcomes is not well established. This retrospective study found that leadership walkrounds participation was strongly associated with positive safety climates and greater risk reductions. While the application of leadership walkrounds varies widely from institution to institution, this multicenter study used a standardized strategy that included monthly hospital executive visits and scripted, open-ended questions meant to engage staff in patient safety discussions. An AHRQ WebM&M perspective discussed the importance of involving hospital leadership with safety and quality.