Background: In healthcare, ensuring safety is crucial for quality care and patient outcomes. While research links leader–member exchange (LMX) quality to safety behavior, this remains understudied in healthcare. Our study explores LMX's long-term impact on safety behavior, proposing a model that includes the moderated mediating role of psychological safety and job satisfaction in the relationship between LMX and safety behaviors, regarding compliance (SCB) and participation (SPB). By identifying the mechanisms through which LMX influences safety behavior, this study can provide insights into the development of interventions that promote workplace safety and enhance the well-being of healthcare workers. Methods: We collected data from 325 Algerian healthcare workers across three public hospitals at three points. Through SmartPLS analysis, we used advanced features of Partial Least Squares Structural Equation Modeling (PLS-SEM) alongside PROCESS analysis to evaluate the relationships within our proposed model. Results: Our analysis found a significant association between higher LMX and increased job satisfaction that positively correlated with enhanced SCB adherence and mediated the LMX–SCB relationship. This relationship was strengthened with high psychological safety. Conclusion Our study emphasizes the crucial role of LMX quality in shaping safety behavior among Algerian healthcare workers, providing insights for cultivating a safety culture in healthcare settings, highlighting the significance of prioritizing LMX, JS, and PS to improve workplace safety and support healthcare worker well-being.