Past studies have suggested a potential link between safety culture and safety performance in the hospital setting. This study explores that relationship further in the Veterans Affairs system by similarly evaluating the impact of positive safety climate on the incidence of Patient Safety Indicators (PSIs). Despite limitations in the use of PSIs to measure performance, the study found that the dimensions that affect staff behavior most directly (e.g., fear of blame and punishment) were in fact related to a few of the PSIs. They also report that frontline workers' perceptions of safety were more strongly associated with selected PSIs than those of senior managers. A past AHRQ WebM&M perspective interviews a leading expert about the importance of safety climate and culture.