Open access. Implementing management innovations to improve safety of healthcare delivery is a critically important, yet often elusive, goal for healthcare organisations. Safety rounds, in which senior executives spend time on the frontlines of care, talking with staff and observing work, aim to improve safety of healthcare delivery by providing a systematic approach for engaging senior executives with the work system challenges faced by front-line staff and ensuring follow-up and accountability for addressing these challenges. They resemble ‘Management by Walking Around’, which originated at Hewlett-Packard1 and ‘gemba walks’, which are considered a key component of the Toyota Production System.2 However, descriptions of these precursor interventions emphasise engagement of senior executives with front-line workers and not follow-up and feedback about ideas generated through observation and discussion. Perhaps unlike in healthcare delivery, 3 follow up and feedback in technology and manufacturing companies can be assumed.