The Patient Handling Injuries Review of Systems (PHIRES) Toolkit was developed to address a gap in the investigative processes that inform the review and revision of control measures in the prevention of musculoskeletal disorders (MSDs) from patient handling (see Newnam & colleagues, 2020). The PHIRES Toolkit is underpinned by a system-thinking approach comprising Rasmussen's Risk Management framework and the associated Accimap technique (1997). It is designed to guide practitioners in the healthcare sector to investigate incidents following the report of a MSD from patient handling. This study extends upon the initial development and evaluation of the Toolkit and presents the key findings from the implementation of the PHIRES Toolkit within six health services in an Australian state jurisdiction. The aim of this study was to (i) present the contributory factors identified in the PHIRES Toolkit reviews and (ii) evaluate the extent to which the PHIRES Toolkit was successful in facilitating a systems thinking approach to investigating MSDs from patient handling and the actions generated to improve staff safety. The results of this study support the strength of a system-thinking method for driving systemic change across the healthcare sector.