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Introduction: Safety performances are an important factor for health organizations, especially nursing organizations aiming to ensure the safety of both providers and customers. Research objectives: This study aimed to: (a) assess perceived safety leadership, safety management, safety culture, and safety performance of head nurses working at regional hospitals under the jurisdiction of the Ministry of Public Health; and (b) construct a structural equation model of the structural relationships among these four variables and test model fit of an empirical data. Research methodology: This is a quantitative study. Data were collected from 331 head nurses using a five-point rating scale questionnaire consisting of four domains, namely, perceived safety leadership, safety management, safety culture, and safety performance. Results: Finding showed that the average scores of all four dimensions of perceived safety were at a high level. The structural equation model of safety performance of head nurses was well fit with an empirical data (CMIN/DF= 1.96, GFI= 0.93, AGFI= 0.91, CFI= 0.99, RMSEA = 0.05). Safety leadership, safety management, and safety culture together explained 65% of the variation in safety performance. Safety leadership had positive direct effects on both safety management (β= .90, p< .01) and safety culture (β= .34, p< .01). On the other hand, safety management had a positive direct effect on safety culture (β= .57, p< .01). On one hand, safety culture had a positive direct effect on safety performance (TE = 0.81, p<0.01), while safety leadership and safety management had a statistically significant indirect effect on safety performance (TE= .69, p< .01). Conclusions: The structural equation model of the structural relationship of safety performance can be well applied in the real situation. Implication: It is recommended that the administrators of nursing organizations include the results of this study as one of the criteria for recruitment of head nurses who must demonstrate safety leadership. The results can be used to guide the development of training programs in safety leadership and safety management of nursing administrators. Promotion of safety culture must be put in place to make effective safety practices under the management of head nurses. Consequently, the better nursing care quality would be attained.
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