Establishing a culture of safety, in which workers at all levels are encouraged to report errors, openly discuss mistakes, and contribute to solutions, is thought to be essential to improving patient safety. However, prior research has documented that perceptions of safety culture may vary widely between clinical units and provider levels. This study administered a previously validated safety culture survey to managers at 92 US hospitals, and found that perceptions of safety culture varied even among managers at different levels. As documented in prior research, more senior managers generally had better perceptions of safety than did lower-ranking managers. Impaired safety culture has been implicated as a factor in high-profile errors in health care and other industries.