A social exchange perspective for achieving safety culture in healthcare organizations

• Pages: 142-156
• DOI: https://doi.org/10.1108/IJPSM-06-2017-0168
• Date: 04 March 2019
• Published date: 04 March 2019
• Author: Elisabetta Trinchero,Ben Farr-Wharton,Yvonne Brunetto
• Subject Matter: Public policy & environmental management,Politics,Public adminstration & management

A social exchange perspective for

achieving safety culture in

healthcare organizations

Elisabetta Trinchero

Government, Health and Not for Profit,

CERGAS –SDA Bocconi School of Management, Milano, Italy

Ben Farr-Wharton

University of Technology, Sydney, Australia, and

Yvonne Brunetto

Southern Cross Business School, Southern Cross University, Bilinga, Australia

Abstract

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.

Keywords Social exchange theory, Healthcare organization, Safety culture

Paper type Research paper

The cost of patient and employee safety breaches continues to be a problem for healthcare

organisations’managers, who are concerned with addressing those safety culture issues

that increase the potential for patient morbidity and mortality (Colla et al., 2005). The safety

culture of an organisation has been defined as “the product of individual and group values,

attitudes, perceptions, competencies, and patterns of behaviour that determine the

commitment to, and the style and proficiency of, an organisation’s health and safety

management”(ACSNI, 1993, p. 23).

Unlike other high-reliability organisations (such as the nuclear or aviation industries)

that monitor safety by rigorous process planning, healthcare organisations use a patient-

centred model, which is far harder to control because humans are less predictable than

capital equipment (Resar, 2006). Additionally, workloads are high in many healthcare

organisations, which potentially can compromise patient safety irrespective of the quality of

organisational safety processes in place (Abdelhadi and Drach-Zahavy, 2012). Hence, the

World Health Organization is driving a global initiative aimed at reducing workplace and

patient accidents (www.who.int/patient-safety), that need to be embedded in a strong safety

culture within a holistic organisational approach (Singer and Vogus, 2013).

The assumption is that if a positive safety culture can be embedded, then the result will

be a significant reduction in errors and accidents (Sorra and Nieva, 2004). Although the

relevance of safety culture for high-risk organisations is increasingly becoming evident, at

International Journal of Public

Sector Management

Vol. 32 No. 2, 2019

pp. 142-156

© Emerald PublishingLimited

0951-3558

DOI 10.1108/IJPSM-06-2017-0168

Received 20 June 2017

Revised 24 December 2017

5 March 2018

7June2018

Accepted 12 June 2018

The current issue and full text archive of this journal is available on Emerald Insight at:

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