Objectives: To examine whether safety culture evolved in Belgian hospitals after a period of three years and to explore the opportunities for benchmarking. Methods: Patient safety culture was measured on 12 dimensions using the validated versions of the Belgian Hospital Survey on Patient Safety Culture. Hospitals were invited to participate in a second nationwide benchmark database. Results: In total, the benchmark database contains the safety culture perceptions of 115 764 respondents from 176 hospitals. Of these, 147 hospitals conducted a first measurement (53.6% response rate) and 140 hospitals repeated the measurement after three years (50.6% response rate). For 111 hospitals which participated twice in the benchmark initiative, it was possible to calculate the evolution of safety culture. Within the acute hospitals, significant improvement was observed for most dimensions, with major improvement for Management support for patient safety and a slight decrease for Handoffs and transitions and Frequency of events reported. Within the psychiatric hospitals, there was a significant improvement for Management support for patient safety and within the long-term care hospitals, there was a significant improvement for Non-punitive response to error. ; Limburg Sterk Merk