Over the past few years, the patient safety world has embraced the concept of HROs. Personally, I find the concept intriguing, but wonder whether it is something of a healthcare “MacGuffin.” Legendary film director Alfred Hitchcock used to love to insert a MacGuffin—a plot device, such as a piece of jewelry, a stack of important-looking papers, or a suitcase, that “motivates the characters or advances the story, but the details of which are of little or no importance otherwise”—into his films. Similarly, when I hear a healthcare organization pledge to become an HRO, I wonder whether they are trying to advance their own “patient safety story” without committing themselves to an actionable or measurable target. In this, I find myself agreeing with British safety expert Charles Vincent, who wrote, “Put simply, reading the HRO literature offers a great deal of inspiration, but little idea of what to do in practice to enhance safety.”4,5