This retrospective study explored whether staff perceptions of organizational culture at the Department of Veterans Affairs (VA) were associated with large-scale adverse events. The authors found an inverse association between a supportive organizational culture and the incidence of large-scale adverse events. Results suggest that in hospitals with reciprocal engagement (i.e., staff perceptions that the organization cares about the employee), staff are more likely to adhere to safety practices that prevent or mitigate large-scale adverse events.