A social exchange perspective for achieving safety culture in healthcare organizations

Purpose: Using social exchange theory (SET) and Cooper’s (2000) model, the purpose of this paper is to operationalise a comprehensive model of safety culture and tests whether SET factors (supervisor-employee relationships and engagement) predict safety culture in a causal chain. Design/methodology/approach: The model was tested using surveys from 648 healthcare staff in an Italian acute care hospital and analysed using structural equation modelling. Findings: Safety behaviours of clinical staff can be explained by the quality of the supervisor-employee relationship, their engagement, their feelings about safety and the quality of organisational support. Practical implications: The model provides a roadmap for strategically embedding effective safe behaviours. Management needs to improve healthcare staff’s workplace relationships to enhance engagement and to shape beliefs about safety practices. Originality/value: The contribution of this paper is that it has empirically developed and tested a comprehensive model of safety culture that identifies a causal chain for healthcare managers to follow so as to embed an effective safety culture.