Leader-Member Exchange and Incident Reporting in Healthcare: Mediating Processes and Moderators

Building on social exchange and social identity theory, we examined how leader-member exchange (LMX) influences reporting of incidents in healthcare organizations through two different mechanisms. Using survey data of 15 hospitals in Germany (N = 436) and structural equation modelling, we found that LMX increased both reporting-specific trust and organizational identification of employees, which in turn positively affected reporting of incidents. Furthermore, management support for patient safety moderated the link between LMX and reporting-specific trust, indicating a compensatory effect of LMX for followers who perceive management support to be low. In addition, codification of patient safety regulations moderated the link between organizational identification and reporting of incidents, indicating that the institutionalization of patient safety norms through a strong follow-through of the organization facilitates reporting for highly-identified employees. Results are discussed in terms of how safety leadership can be enacted at both the supervisory and management level in order to promote safety behaviour in healthcare organizations.