Focused on achieving improvements in patient safety and quality, the United Kingdom’s Safer Patients Initiative (SPI) is a large-scale effort targeting 24 care organizations. The initiative emphasizes changes at the organizational level, improvements in reliability of frontline care processes, and careful attention to communication, leadership, and safety culture. This study evaluated perceptions among managers and frontline staff participating in the SPI and found a number of differing opinions on the same elements of the program. For instance, managers were likely to report a more positive outcome and larger improvements on staff morale and job satisfaction, whereas staff perceived greater improvements in the timeliness of care delivered. The authors suggest that their findings carry important implications as the differing perceptions identified may provide key strategies for understanding and monitoring success of such initiatives moving forward.