Impact of organizational culture on safety performance: Exploring the mediating role of safety attitudes in healthcare sector.
DOI:
https://doi.org/10.71085/sss.04.03.353Keywords:
Organizational Culture, Safety Attitudes, Safety Performance, Nursing, Indus HospitalAbstract
This study investigated the mediating role of safety attitudes in the relationship between organizational culture and safety performance among nurses. A cross-sectional quantitative design was used with purposive sampling, and data were gathered from 198 nurses working across five branches of Indus Hospital, Pakistan. Organizational culture was assessed using the Organizational Culture Assessment Questionnaire (OCAQ), safety attitudes were measured with the Safety Attitudes Questionnaire (SAQ), and safety performance was evaluated across four dimensions: safety compliance and safety participation (Griffin & Neal, 2000), as well as safety outcomes and employee satisfaction (Fernandez et al., 2009). Data analysis was conducted using SPSS 26, with mediation tested through Structural Equation Modeling (SEM). Findings indicated significant positive associations among organizational culture, safety attitudes, and safety performance. Organizational culture positively predicted both safety attitudes and safety performance, while safety attitudes significantly enhanced safety performance. Importantly, safety attitudes mediated the relationship between organizational culture and safety performance. These results emphasize the role of safety attitudes as psychological pathway through which organizational culture shapes safety outcomes. The study contributes to occupational health and safety literature by offering evidence from the nursing context and provides practical implications for healthcare management to strengthen safety culture and promote safer practices.
Downloads
References
Aiken, L. H., Sloane, D. M., Clarke, S., Poghosyan, L., Cho, E., You, L., ... & Aungsuroch, Y. (2011). Importance of work environments on hospital outcomes in nine countries. International Journal for Quality in Health Care, 23(4), 357-364. https://doi.org/10.1093/intqhc/mzr022.
Akhavan, P., Ebrahim Sanjaghi, M., Rezaeenour, J., & Ojaghi, H. (2014). Examining the relationships between organizational culture, knowledge management and environmental responsiveness capability. VINE: The journal of information and knowledge management systems, 44(2), 228-248. https://doi.org/10.1108/VINE-07-2012-0026.
Alanazi, F. K., Sim, J., & Lapkin, S. (2022). Systematic review: Nurses' safety attitudes and them Impact on patient outcomes in acute‐care hospitals. Nursing open, 9(1), 30-43. https://doi.org/10.1002/nop2.1063.
Alhalwani, A., Husain, A., Saemaldahar, A., Makhdoum, F., Alhakami, M., Ashi, R., ... & Fasfous, I. (2024). The impact of alcohol hand sanitizer uses on skin health between healthcare worker: Cross‐sectional study. Skin Research and Technology, 30(1), e13527. https://doi.org/10.1111/srt.13527.
Andres, E. B., Song, W., Schooling, C. M., & Johnston, J. M. (2019). The influence of hospital accreditation: a longitudinal assessment of organisational culture. BMC health services research, 19(1), 467. https://doi.org/10.1186/s12913-019-4279-7.
Arzahan, I. S. N., Ismail, Z., & Yasin, S. M. (2022). Safety culture, safety climate, and safety performance in healthcare facilities: a systematic review. Safety science, 147, 105624. https://doi.org/10.1016/j.ssci.2021.105624.
Asante, J. O., Li, M. J., Liao, J., Huang, Y. X., & Hao, Y. T. (2019). The relationship between psychosocial risk factors, burnout and quality of life among primary healthcare workers in rural Guangdong province: a cross-sectional study. BMC health services research, 19(1), 447. https://doi.org/10.1186/s12913-019-4278-8.
Askaripoor, T., Siadat, M., Saleh, E., & Aghaei, H. (2024). Resilience, job satisfaction, occupational stress, and occupational accidents among healthcare professionals: A Bayesian network analysis. Work, 79(3), 1357-1367. https://doi.org/10.3233/WOR-240178.
Bagga, S. K., & Kumar, S. (2025). Employee change readiness effect on employee engagement and organisational commitment in the Indian pharmaceutical sector: an empirical study. Progress in Industrial Ecology, an International Journal, 18(1), 58-87. https://doi.org/10.1504/PIE.2025.148051.
Baird, K., Su, S., & Tung, A. (2018). Organizational culture and environmental activity management. Business Strategy and the Environment, 27(3), 403-414. https://doi.org/10.1002/bse.2006.
Bhuiyan, F., Baird, K., & Munir, R. (2020). The association between organisational culture, CSR practices and organisational performance in an emerging economy. Meditari Accountancy Research, 28(6), 977-1011. https://doi.org/10.1108/MEDAR-09-2019-0574.
Bondevik, G. T., Hofoss, D., Hansen, E. H., & Deilkås, E. C. T. (2014). The safety attitudes questionnaire–ambulatory version: psychometric properties of the Norwegian translated version for the primary care setting. BMC health services research, 14(1), 139. https://doi.org/10.1186/1472-6963-14-139.
Bortolotti, T., Boscari, S., & Xiao, C. Y. (2024). Leveraging organizational culture to create competitive value from environmental practices. International Journal of Production Economics, 272, 109252. https://doi.org/10.1016/j.ijpe.2024.109252.
Brattig, B., Schablon, A., Nienhaus, A., & Peters, C. (2014). Occupational accident and disease claims, work-related stress and job satisfaction of physiotherapists. Journal of Occupational Medicine and Toxicology, 9(1), 36. https://doi.org/10.1186/s12995-014-0036-3.
Brauer, M. (2006). What have we acquired and what should we acquire in divestiture research? A review and research agenda. Journal of management, 32(6), 751-785. https://doi.org/10.1177/0149206306292879.
Brewer, B. B. (2006). Relationships among teams, culture, safety, and cost outcomes. Western Journal of Nursing Research, 28(6), 641-653. https://doi.org/10.1177/0193945905282303.
Buljac-Samardzic, M., Van Wijngaarden, J. D., & Dekker–van Doorn, C. M. (2016). Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands. BMJ quality & safety, 25(6), 424-431. https://doi.org/10.1136/bmjqs-2014-003397.
Bwonya, J. E., Ogutu, M., & Okeyo, W. O. (2020). Leadership style, organizational culture and performance: A critical literature review. Journal of Human Resource & Leadership, 4(2), 48-69.https://stratfordjournalpublishers.org/journals/index.php/journal-of-human- resource/article/view/507.
Campbell, J. P., Gasser, M. B., & Oswald, F. L. (1996). The substantive nature of job performance variability. Individual differences and behavior in organizations, 258, 299.
Campbell, S. M. (2013). An investigation of a railroad safety training program on the relationship between self-efficacy and safety climate attitudes. Capella University.
Carvalho, A. M., Sampaio, P., Rebentisch, E., McManus, H., Carvalho, J. Á., & Saraiva, P. (2023). Operational excellence, organizational culture, and agility: bridging the gap between quality and adaptability. Total Quality Management & Business Excellence, 34(11-12), 1598-1628. https://doi.org/10.1080/14783363.2023.2191844.
Chinene, B., Mudadi, L., Mutandiro, L., Mushosho, E. Y., & Matika, W. (2023). Radiographers’ views on the workplace factors that impact their mental health: findings of a survey at central hospitals in Zimbabwe. Journal of Medical Imaging and Radiation Sciences, 54(2), S51- S61. https://doi.org/10.1016/j.jmir.2023.02.013.
Chung, H. J., & Ahn, S. H. (2019). Relationship between organizational culture and job satisfaction among Korean nurses: A meta-analysis. Journal of Korean Academy of Nursing Administration, 25(3), 157-166. https://doi.org/10.11111/jkana.2019.25.3.157.
De Koster, R. B., Stam, D., & Balk, B. M. (2011). Accidents happen: The influence of safety specific transformational leadership, safety consciousness, and hazard reducing systems on warehouse accidents. Journal of Operations management, 29(7-8), 753-765. https://doi.org/10.1016/j.jom.2011.06.005.
Dickens, G. L., Salamonson, Y., Ramjan, L., Steel, K., & Everett, B. (2019). Safety attitudes, perceived organizational culture and knowledge of the physiologically deteriorating patient among mental health nurses: Cross‐sectional, correlational study. International journal of mental health nursing, 28(6), 1347-1362. https://doi.org/10.1111/inm.12649.
Draghici, Anca, Salih Dursun, Oğuz Bașol, Maria Elena Boatca, and Alin Gaureanu. "The mediating role of safety climate in the relationship between transformational safety leadership and safe behavior—The case of two companies in Turkey and Romania." Sustainability 14, no. 14 (2022): 8464. https://doi.org/10.3390/su14148464.
Ellis, W. E., Dumas, T. M., & Forbes, L. M. (2020). Physically isolated but socially connected: Psychological adjustment and stress among adolescents during the initial Covid-19 crisis. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 52(3), 177. https://doi.org/10.1037/cbs0000215.
Fernández-Muñiz, B., Montes-Peón, J. M., & Vázquez-Ordás, C. J. (2009). Relation between occupational safety management and firm performance. Safety science, 47(7), 980-991. https://doi.org/10.1016/j.ssci.2008.10.022.
Fernández-Muñiz, B., Montes-Peón, J. M., & Vázquez-Ordás, C. J. (2014). Safety leadership, risk management and safety performance in Spanish firms. Safety science, 70, 295-307. https://doi.org/10.1016/j.ssci.2014.07.010.
Fernández-Muñiz, B., Montes-Peón, J. M., & Vázquez-Ordás, C. J. (2012). Safety climate in Ohsas 18001-certified organisations: Antecedents and consequences of safety behaviour. Accident Analysis & Prevention, 45, 745-758. https://doi.org/10.1016/j.aap.2011.10.002.
Ghahramani, A., & Khalkhali, H. R. (2015). Development and validation of a safety climate scale for manufacturing industry. Safety and health at work, 6(2), 97-103. https://doi.org/10.1016/j.shaw.2015.01.003.
Gonçalves, L., Sala, R., & Navarro, J. B. (2022). Resilience and occupational health of health care workers: a moderator analysis of organizational resilience and sociodemographic attributes. International archives of occupational and environmental health, 95(1), 223-232. https://doi.org/10.1007/s00420-021-01725-8.
Griffin, M. A., & Neal, A. (2000). Perceptions of safety at work: a framework for linking safety climate to safety performance, knowledge, and motivation. Journal of occupational health psychology, 5(3), 347. https://doi.org/10.1037//1076-8998.5.3.347.
Griffin, M. A., & Curcuruto, M. (2016). Safety climate in organizations. Annual review of organizational psychology and organizational behavior, 3(1), 191-212. https://doi.org/10.1146/annurev-orgpsych-041015-062414.
Groysberg, B., Lee, J., Price, J., & Cheng, J. (2018). The leader’s guide to corporate culture. Harvard business review, 96(1), 44-52.
Halim, N. A., Salleh, S. M., Sobry, S. C., & Halim, M. K. A. (2024). Fostering employee well- being: The role of occupational safety and health in modern working policies. International Journal of Research and Innovation in Social Science, 8(10), 55-62. https://dx.doi.org/10.47772/IJRISS.2024.8100005.
Hämäläinen, P., Takala, J., & Saarela, K. L. (2006). Global estimates of occupational accidents. Safety science, 44(2), 137-156. Hämäläinen, P., Takala, J., & Saarela, K. L. (2006). Global estimates of occupational accidents. Safety science, 44(2), 137-156. https://doi.org/10.1016/j.ssci.2005.08.017.
Hammons, L. (2013). Relationships among non-academic employee perceptions of manager leadership behaviors, meaningful work, and selected performance drivers (Doctoral dissertation). https://hdl.handle.net/1969.1/150927.
Hardcopf, R., Liu, G. J., & Shah, R. (2021). Lean production and operational performance: The influence of organizational culture. International Journal of Production Economics, 235, 108060. https://doi.org/10.1016/j.ijpe.2021.108060.
Harvey, J., Erdos, G., Jackson, H., & Dennison, S. (2004). Is safety culture in differing organizations the same thing? A comparison of safety culture measures in three organizations. Risk Decision and Policy, 9(4), 391-400. https://doi.org/10.1080/14664530490896690.
Hayes, N., O'Toole, L., & Halpenny, A. M. (2022). Introducing Bronfenbrenner: A guide for practitioners and students in early years’ education. Routledge. https://doi.org/10.4324/9781003247760.
Hien, N. N., Kiet, N. T., & Nguyen, A. T. (2024). The Influence of Safety Culture on Safety Attitude, Personnel Error Behavior, and Safety Citizenship Behavior: Research in the Vietnam Oil and Gas Industry. International Journal of Safety & Security Engineering, 14(2). https://doi.org/10.18280/ijsse.140208.
Hogden, A., Ellis, L., Churruca, K., & Bierbaum, M. (2017). Safety culture assessment in health care: A review of the literature on safety culture assessment modes.
Hong, S. J. (2015). Perception of safety attitude and priority and progress of safe practices of nurses in emergency services hospitals. Adv Sci Lett, 104, 156-163. http://dx.doi.org/10.14257/astl.2015.104.34.
Hoskins, R. A. J. (2009). Health Visiting—The end of a UK wide service? Health policy, 93(23), 93-101. https://doi.org/10.1016/j.healthpol.2009.08.001.
Hwang, J. I., Kim, S. W., & Park, H. A. (2021). Relationships between nurses’ work system, safety-related performance, and outcomes: a structural equation model. Journal of Patient Safety, 17(8), e1638-e1645. https://doi.org/10.1097/PTS.0000000000000866.
Inness, M., Turner, N., Barling, J., & Stride, C. B. (2010). Transformational leadership and employee safety performance: a within-person, between-jobs design. Journal of occupational health psychology, 15(3), 279. https://doi.org/10.1037/a0019380.
Isensee, C., Teuteberg, F., Griese, K. M., & Topi, C. (2020). The relationship between organizational culture, sustainability, and digitalization in SMEs: A systematic review. Journal of cleaner production, 275, 122944. https://doi.org/10.1016/j.jclepro.2020.122944.
Kava, C. M., Parker, E. A., Baquero, B., Curry, S. J., Gilbert, P. A., Sauder, M., & Sewell, D. K. (2018). Organizational culture and the adoption of anti-smoking initiatives at small to very small workplaces: An organizational level analysis. Tobacco prevention & cessation, 4, 39. https://doi.org/10.18332/tpc/100403.
Körner, M., Wirtz, M. A., Bengel, J., & Göritz, A. S. (2015). Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams. BMC health services research, 15(1), 243. https://doi.org/10.1186/s12913-015-0888-y.
Lee, S. E., Scott, L. D., Dahinten, V. S., Vincent, C., Lopez, K. D., & Park, C. G. (2019). Safety culture, patient safety, and quality of care outcomes: a literature review. Western journal of nursing research, 41(2), 279-304. https://doi.org/10.1177/0193945917747416.
Liu, X., Huang, G., Huang, H., Wang, S., Xiao, Y., & Chen, W. (2015). Safety climate, safety behavior, and worker injuries in the Chinese manufacturing industry. Safety science, 78, 173-178. https://doi.org/10.1016/j.ssci.2015.04.023.
Liu, Y. J., Chen, J. L., Cheng, S. Y., Hsu, M. T., & Wang, C. H. (2014). Evaluation of safety performance in process industries. Process Safety Progress, 33(2), 166-171. https://doi.org/10.1002/prs.11644.
Malakoutikhah, M., Jahangiri, M., Alimohammadlou, M., Faghihi, S. A., & Kamalinia, M. (2021). The factors affecting unsafe behaviors of Iranian workers: a qualitative study based on grounded theory. Safety and Health at Work, 12(3), 339-345. https://doi.org/10.1016/j.shaw.2021.04.005.
Marchand, A., Simard, M., Carpentier-Roy, M. C., & Ouellet, F. (1998). From a unidimensional to a bidimensional concept and measurement of workers' safety behavior. Scandinavian journal of work, environment & health, 293-299. https://www.jstor.org/stable/40966778.
Martínez-Córcoles, M., Gracia, F., Tomás, I., & Peiró, J. M. (2011). Leadership and employees’ perceived safety behaviours in a nuclear power plant: A structural equation model. Safety science, 49(8-9), 1118-1129. https://doi.org/10.1016/j.ssci.2011.03.002.
Mapuvire, D. H., Chilunjika, S. R., & Mutasa, F. (2022). The health and safety perspectives in the Zimbabwe public sector. In Transformational human resources management in Zimbabwe: Solutions for the public sector in the 21st century (pp. 167-185). Singapore: Springer Nature Singapore. https://doi.org/10.1007/978-981-19-4629-5_11.
Mashi, M. S., Subramaniam, C., Johari, J., & Suleiman Abubakar, S. (2023). Understanding safety management practices and safety performance amid coronavirus (Covid-19) pandemic
among nurses in public hospitals. International Journal of Public Administration, 46(10), 716-727. https://doi.org/10.1080/01900692.2021.2012803.
Mearns, K., Whitaker, S. M., & Flin, R. (2003). Safety climate, safety management practice and safety performance in offshore environments. Safety science, 41(8), 641-680. https://doi.org/10.1016/S0925-7535(02)00011-5.
Meyers, P. M., Coon, A. L., Kan, P. T., Wakhloo, A. K., & Hanel, R. A. (2019). SCENT Trial: one-year outcomes. Stroke, 50(6), 1473-1479. https://doi.org/10.1161/STROKEAHA.118.024135.
Mousavi, S. S. (2018). Measuring the impact of lean implementation on occupational health and safety through leading indicators.
Naji, Gehad Mohammed Ahmed, Ahmad Shahrul Nizam Isha, Mysara Eissa Mohyaldinn, Stavroula Leka, Muhammad Shoaib Saleem, Syed Mohamed Nasir Bin Syed Abd Rahman, and Mohammed Alzoraiki. "Impact of safety culture on safety performance; mediating role of psychosocial hazard: An integrated modelling approach." International journal of environmental research and public health 18, no. 16 (2021): 8568. https://doi.org/10.3390/ijerph18168568.
Needle, D. (2004). Business in context: An introduction to business and its environment by David Needle.
Nieva, V. F., & Sorra, J. (2003). Safety culture assessment: a tool for improving patient safety in healthcare organizations. BMJ quality & safety, 12(suppl 2), ii17-ii23. https://doi.org/10.1136/qhc.12.suppl_2.ii17.
Nisar, N., Saat, N. Z. M., Nata, D. H. M. S., Kamaludin, N. F., Ishak, I., & Ahmad, A. M. R. (2025). The mediating role of safety behavior in the relationship between safety climate and safety outcomes among sanitary workers in Pakistan. Frontiers in Public Health, 13, 1591691. https://doi.org/10.3389/fpubh.2025.1591691.
Nunnally, J. C. (1978). An overview of psychological measurement. Clinical diagnosis of mental disorders: A handbook, 97-146. https://doi.org/10.1007/978-1-4684-2490-4_4.
Pramusiwi, W. M., Hariyono, W., & Ruliyandari, R. (2024). Analysis of Occupational Safety and Health (OSH) Risks in Hospitals: Literature Review. Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 7(8), 2051-2061. https://doi.org/10.56338/mppki.v7i8.5654.
Raeissi, P., Reisi, N., & Nasiripour, A. A. (2018). Assessment of patient safety culture in Iranian academic hospitals: strengths and weaknesses. Journal of patient safety, 14(4), 213-226. https://doi.org/10.1097/PTS.0000000000000199.
Samaei, S. E., Raadabadi, M., Khanjani, N., Heravizadeh, O., Hosseinabadi, M. B., & PIRANI, S. (2015). Safety attitudes among nurses and its relation with occupational accidents: a questionnaire based survey. International Journal of Occupational Hygiene, 7(4), 177-186. http://ijoh.tums.ac.ir.
Sashkin, M., & Rosenbach, W. E. (1990). Organizational culture assessment questionnaire. Marshall Sashkin.
Schein, E. H. (1992). How can organizations learn faster? the problem of entering the Green Room.
Sexton, J. B., Helmreich, R. L., Neilands, T. B., Rowan, K., Vella, K., Boyden, J., ... & Thomas, E. J. (2006). The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC health services research, 6(1), 44. https://doi.org/10.1186/1472-6963-6-44.
Singer, S., Lin, S., Falwell, A., Gaba, D., & Baker, L. (2009). Relationship of safety climate and safety performance in hospitals. Health services research, 44(2p1), 399-421. https://doi.org/10.1111/j.1475-6773.2008.00918.x.
Tadesse Bogale, A., & Debela, K. L. (2024). Organizational culture: a systematic review. Cogent Business & Management, 11(1), 2340129. https://doi.org/10.1080/23311975.2024.2340129.
Takougang, I., Lekeumo Cheuyem, F. Z., Ndungo, J. H., Lyonga, E. E., & Mbopi-Keou, F. X. (2023). Infection Risk Perception, Reporting and Post-Exposure Management of Occupational Injuries Among Healthcare Workers in District Hospitals (Yaoundé, Cameroon). medRxiv, 2023-08. https://doi.org/10.1101/2023.08.29.23294797.
Taylor, J. A., Dominici, F., Agnew, J., Gerwin, D., Morlock, L., & Miller, M. R. (2012). Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions. BMJ quality & safety, 21(2), 101-111. https://doi.org/10.1136/bmjqs-2011-000082.
Vinodkumar, M. N., & Bhasi, M. (2010). Safety management practices and safety behaviour: Assessing the mediating role of safety knowledge and motivation. Accident Analysis & Prevention, 42(6), 2082-2093. https://doi.org/10.1016/j.aap.2010.06.021.
Wahid, A., & Hussian, S. (2024). Frequency of psychosocial stress and its relationship to safety attitude towards nurse’s performance at tertiary care hospitals. Pakistan Journal of Medical Sciences, 40(5), 989. https://doi.org/10.12669/pjms.40.5.7913.
Weiner, M. F. (2018). Decolonial sociology: WEB Du Bois's foundational theoretical and methodological contributions. Sociology Compass, 12(8), e12601. https://doi.org/10.1111/soc4.12601.
Wright, L. K., Jatrana, S., & Lindsay, D. (2024). Remote area nurses' experiences of workplace safety in very remote primary health clinics: A qualitative study. Journal of Advanced Nursing, 80(8), 3298-3308. https://doi.org/10.1111/jan.16028.
Zhang, L., & Gao, Y. (2012). Safety culture model and influencing factors analysis in construction enterprises of China. Research Journal of Applied Sciences, Engineering and Technology, 4(18), 3297-312.
Downloads
Published
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
.png)
