This study investigated two contributing factors in predicting adverse events in hospital settings. We approached this issue using the statistical procedure of hierarchical linear modeling to test for multilevel relationships. We found that the resource intensity of the presenting case was related to the severity level of negative incidents in hospital settings in a large metropolitan center. More important, we found that a more positive culture of patient safety within hospital units was related to lower incident severity. More than 8,000 admissions within 40 different units in three hospitals were included in the analyses.