The aim of the Patient Centered Medical Home (PCMH) model is to reorganize primary care services to ensure team-based, coordinated, system-orientation, and accessible care is provided to patients. Using PCMH characteristic data, interviews and surveys with PCMH clinicians, administrators and staff, this study identified four key factors contributing to higher safety culture in PCMHs: (1) leadership in patient safety; (2) reciprocity in advice-seeking; (3) self-efficacy and job satisfaction, and; (4) quality improvement climate. The authors suggest that interventions to improve ambulatory patient safety should focus on leadership and clinician and staff advice-seeking relationships.