Region Östergötland engages in many international collaborations as a way to exchange knowledge and insights with other organizations. The organization has had a collaboration focused on patient safety with Moi Teaching and Referral Hospital in Eldoret, Kenya, since 2015. Kenya is considered a low and middle-income country, while Sweden is considered a high-income country. The aim of this study was to describe patient safety development using activity theory, with a special focus on how Region Östergötland supports patient safety development in a low and middle-income country’s healthcare system. Data was collected by conducting interviews with six participants involved in the patient safety collaboration, by visiting Eldoret to conduct a participant observation and by analyzing relevant policy documents. The results showed that many factors are involved in patient safety development, both within an organization and in supporting the development in a low and middle-income country’s healthcare system. Healthcare organizations should strive for commitment to patient safety development from all levels of the organization, and for a safety culture where staff members are comfortable reporting errors. The management must pursue patient safety questions and put aside resources for patient safety development. As Sweden and low and middle-income countries are different in many aspects, it’s important for the supporting part, in this case Region Östergötland, to be attentive to and understanding of prevailing differences caused by available resources, cultural norms, rules and organizational structures. Many of the requirements for an organization’s patient safety development, and for a successful collaboration between Region Östergötland and Moi Teaching and Referral Hospital, were shown to be achieved or at least functioning. Even though all requirements are not fulfilled, they are all matters that can be improved by the continuation of the collaboration. Region Östergötland can learn from the collaboration by seeing how results can be achieved in an organization with few resources, how efficiently changes can be made within an organization, as well as by gaining knowledge about another culture and country. These factors create opportunities for project participants to be inspired and question current methods and norms in their own organization, which can result in improvements of Region Östergötland as on organization in the future.