Clinical leadership is at the forefront of many international health systems' reform and modernisation programmes, to deliver improved outcomes in patient safety and health quality. However, despite this strategic emphasis, there is still very little evidence to inform comprehensive and sustainable policy arrangements and inclusive clinical participation. This report describes how the Western Australian health system has developed, deployed and monitored patient safety and clinical governance initiatives since 2001. Specific patient safety improvements include substantially increased deep vein thrombosis (DVT) prophylaxis rates in surgical patients, MRSA rates of 1.1 per 100 000 members of the population, and the achievement of zero catheter-associated bloodstream infections in two major tertiary intensive care units. With optimistic signs that this is an effective model, there is now a demonstrated need for further education training and research into how best to develop and harness clinical leadership to further deliver on the promise of the patient safety movement.