As MUSC clinicians complete the Hospital Survey on Patient Safety Culture, some may wonder what our next steps are. How do we change safety culture? What strategies have sound evidence to support their effectiveness? A systematic review published in the British Medical Journal of Quality and Safety evaluated 2000 articles, of which 21 met the inclusion criteria. One was a cluster randomized controlled trial, 7 were controlled before-after studies, and 13 were historically controlled studies. Interventions that most strongly supported improvements in safety culture were leadership walk rounds and multi-component interventions; most other interventions did not clearly have an effect. Although difficult to design and complete, further research is needed to determine interventions that improve a culture of safety.