There are many examples of health care organizations that have morphed from the culture of low expectation to the culture of excellence. Ethically, to not drive to excellence means that we are settling from knowingly allowing harm to happen on our watch. The leader's obligation is to create that sonic boom that Black and Gregersen (2008) describe to break up the old mind maps, to create the movement, and to finish the cultural change in spite of change fatigue and other factors that could sabotage the process. Only then can the effective leader sleep well at night knowing that the infrastructure is being created that will provide a culture of excellence and safety for patients and their families. And it is being created on his/her watch.