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.