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The purpose of this paper is to examine the relationship between health and safety (H&S) and organisational culture in project business, in particular to explore the validity of current cognitive emphases of linear organisational maturity towards a “safety culture”, and normative models and prescriptions.

An interpretative methodology is employed, informed by ethnography (Douglas' cultural theory) and clinical consultative (Schein's model) approaches, using case‐based analysis comprising seven project business organisations.

The cases were characterized by diverse organisational cultures and diverse H&S practices informed by habits and intuitive behaviour, as well as cognitive strategies and decisions for implementation. H&S was not the top priority for these cases. Good performance related to alignment with the prevailing culture rather than pursuit of a “safety culture”.

The term “safety culture” is misdirected; greater attention on what is, rather than normative models and prescription, is necessary. Generalisation is limited by the case‐based approach.

Practitioners need to pay more attention to organisational culture and alignment of H&S practices, to the unintended consequences of prescriptions, and robust systems.

The way activities are conducted requires awareness of the prevailing culture in order to align the structure and processes to the culture for effective operations. These implications are general, and within project business and management, Failure to do so carries increased risk of failing to satisfy business and broader stakeholder interests.

Anomalies in H&S research and practice are challenged, especially “safety culture” and normative approaches. The contribution is the combination employment of the Schein and Douglas models to understand organisational culture and H&S cultural alignment.