Background: Quality, Safety and Security are embedded in all aspects of port operations and are crucial for port industry stakeholders. Over the past decades, numerous assurance systems, codes, and regulations for quality, safety, and security have been developed and implemented in ports world-wide. This paper examines key insights for the implementation those systems in ports, reviewing over 20 years of empirical research on the impact and outcomes of such systems in Greek ports and internationally. Methods: It compares and discusses evidence from two empirical surveys spanning the first two decades of the 21rst century. The first survey was conducted in 2011 (with evidence from 2000 to 2011) including 12 major Greek ports (SAs) and the second one was conducted up to 2022–2023, including 23 over 25 Greek ports (the same SAs and other ones from the Greek TEN-T network). Results: The higher-level scope of this paper is to investigate critical perspectives on and trends in quality, safety, and security systems in the port industry. Conclusions: This investigation aims to strengthen the assumption that quality, safety, and security play a pivotal role in shaping the image, performance, and growth of ports.