RESEARCH ARTICLE Psychosocial safety climate, emotional exhaustion, and work injuries in healthcare workplaces Amy Jane Zadow 1 | Maureen Frances Dollard 1 | Sarven Savia Mclinton 1 | Peter Lawrence 2 | Michelle Rae Tuckey 1 1 Asia Pacific Centre for Work Health and Safety, University of South Australia, Adelaide, Australia 2 Calvary Healthcare Adelaide, Little Company of Mary Health Care Ltd, Adelaide, Australia Correspondence Amy Jane Zadow, Asia Pacific Centre for Work Health and Safety, University of South Australia, GPO Box 2471, Adelaide 5001, South Australia. Email: amy.zadow@unisa.edu.au Abstract Preventing work injuries requires a clear understanding of how they occur, how they are recorded, and the accuracy of injury surveillance. Our innovation was to examine how psychoso- cial safety climate (PSC) influences the development of reported and unreported physical and psychological workplace injuries beyond (physical) safety climate, via the erosion of psychological health (emotional exhaustion). Self‐report data (T2, 2013) from 214 hospital employees (18 teams) were linked at the team level to the hospital workplace injury register (T1, 2012; T2, 2013; and T3, 2014). Concordance between survey‐reported and registered injury rates was low (36%), indicating that many injuries go unreported. Safety climate was the strongest predictor of T2 registered injury rates (controlling for T1); PSC and emotional exhaustion also played a role. Emotional exhaustion was the strongest predictor of survey‐reported total injuries and underreporting. Multilevel analysis showed that low PSC, emanating from senior managers and transmitted through teams, was the origin of psychological health erosion (i.e., low emotional exhaustion), which culminated in greater self‐reported work injuries and injury underreporting (both physical and psychological). These results underscore the need to consider, in theory and practice, a dual physical–psychosocial safety explanation of injury events and a psychosocial explanation of injury underreporting. KEYWORDS emotional exhaustion, injury underreporting, psychosocial, work injuries, workplace safety 1 | INTRODUCTION Errors and accidents in hospitals are estimated to be the third leading cause of death in the United States (Makary & Daniel, 2016). Accidents leading to work injuries are rising with an estimated cost of $186 billion in the US (Leigh, 2011) and $57.5 billion in Australia (SafeWork Australia, 2012). The main aim of our research is to investi- gate (a) how organisation climate, both physical and psychosocial safety climate (PSC), and worker psychological health, affect how workplace injuries (both physical and psychological) develop; and (2) how these factors affect whether injuries are reported and registered by the organisation. We explore these issues in a multilevel study of hospital employees working in teams, using both survey and registered injury data. Our first aim concerns the causes of workplace injury, and researchers have largely investigated these through separate lines of enquiry: the dominant line has established the role of organisational system factors (such as safety climate), physical hazards, and safety related behaviour (Neal & Griffin, 2006; Zohar, 2008); another emerging line includes psychosocial risk factors (e.g., job design; Clarke, 2012; Nahrgang, Morgeson, & Hofmann, 2011) and psychological health states (e.g., emotional exhaustion; Halbesleben, 2010; Nahrgang et al., 2011) as important predictors of safety behaviour and events. In practice, psychosocial factors at work are not given the same attention in legislation and by health and safety inspectors as physical hazards (Productivity Commission, 2010). Moreover, existing research focuses almost exclusively on physical, rather than the combination of physical and psychological injuries. Accordingly, the influence of physical safety climate as an upstream factor has been extensively explored, without consideration of its psychosocial counterpart—PSC—defined as a climate for worker psychological health and safety (Dollard & Bakker, 2010). Research across Australia and Malaysia shows that PSC in organisations is typ- ically lower than physical safety climate indicating a lack of priority Received: 12 November 2015 Revised: 25 November 2016 Accepted: 14 December 2016 DOI 10.1002/smi.2740 Stress and Health 2017; 1–12 Copyright © 2017 John Wiley & Sons, Ltd. wileyonlinelibrary.com/journal/smi 1