Recognition of the importance of a just and trusting culture has been a focal point in enhancing patient safety; as it stands however, healthcare organizations are impeded by a culture of blame. In the present study, 12 subject matter experts were interviewed regarding behaviors that would create or hinder the development of a just and trusting culture. An additional 29 participants took part in a policy-capturing study that allowed for the direct assessment of identified factors that were seen as important to the development of a just and trusting culture. Violation type, explanation, blame by manager, and blame by organization were all significant predictors of perceptions of trust. The present findings can be useful in terms of developing training systems for managers and organizational executive teams for managing medical error events and ultimately improving patient safety. Research implications and directions for future research are also presented.