To create a deeper culture of safety--an environment in which safety is the first priority of every person in the system--Mercy Health System, St. Louis, has launched a variety of safety and quality initiatives. In September 2005, Mercy began an effort to develop blame-free environments in which the reporting and gathering of data can lead to improvements in patient safety. Mercy's top executives attended Mercy's annual Pathways Leadership Development event in October and November 2005 to discuss the moral and theological imperatives for building a culture of safety. Mercy's leaders addressed six stumbling blocks that have impeded progress toward a culture of safety: production demands and time pressures, absent or inadequate processes, failure to focus on process problems, poor teamwork, inadequate communication, and fear and pride. They have identified five key elements that should enhance patient safety: improved leadership, reporting systems, measurement, best practices, and a supporting structure. For Mercy, the safety initiative is not just about policy change; it's about cultural transformation.