Occupational safety and health management (OSH) systems are considered an important factor in protecting workers from injury and illness. Yet whether and how managers in the apparel sector choose to implement such systems in their factories is not well understood. This paper compares trends in non-compliance with standards regulating OSH management systems, as well as non-compliance with actual OSH conditions in apparel factories. Analyzing data from Better Work Compliance Assessments, factories found in compliance with having OSH management systems in place are generally more likely to be in compliance with standards for OSH conditions in the factory. Trends in OSH management systems and actual OSH conditions are tracked over time, and no clear pattern emerges regarding which element takes hold first in the factory. Through comparison of data from Better Work Compliance Assessments and data from surveys completed by workers and managers as part of the independent Better Work Impact Evaluation, this paper demonstrates that workers perceive similar changes in their working conditions as assessed by Better Work Enterprise Advisors. This seems to suggest that a focus on continuous compliance improvement in OSH can improve working conditions.