Establishing a culture of safety is a cornerstone of efforts to develop high reliability organizations that ensure patient safety. The AHRQ Hospital Survey on Patient Safety Culture is a validated survey that is widely used to assess safety culture. The survey examines organizational perceptions of 12 domains of culture ranging from communication about errors to teamwork within and across units. AHRQ has provided comparative benchmarking user data since 2007. The 2018 report includes data from 630 hospitals, 306 of which provided data for both the 2018 and 2016 databases. Notable changes since 2016 include improvement in the overall perception of safety, with most participating hospitals reporting positive perceptions of management support for safety, teamwork within units, and organizational responses to errors. In contrast, handoffs, staffing, and nonpunitive response to error remained patient safety concerns for nearly half of respondents, with little to no improvement since 2016. A PSNet interview with Professor Mary Dixon-Woods discussed the evolving understanding of safety culture and recent insights into mechanisms driving safety culture improvement.