The management of risks surrounding patient handling activities continues to be an important factor in healthcare organizations. A great deal of research has been undertaken to investigate the best practices for physical transfers and equipment provision, yet there is less research adopting an organizational systems approach to this problem. In this article we compare two methods for assessing safety climate and patient handling safety performance and argue that a multi-level (mesoergonomic) interpretation of the relationship between the two affords insights into the safety of the system as a whole