A game of adoption – but playing by whose rules?

• Litte information is available about adoption of safety concepts. • Explores the reasons why safety professionals adopt safety concepts. • Offers a multi-level approach from macro to micro. • Proposes a conceptual model for adoption of safety concepts. The adoption of safety concepts by safety professionals plays a critical role in shaping organizational safety practices and outcomes. However, there is little systematic integration of the factors that drive safety professionals to adopt particular safety concepts. This integrative systematic literature review explores in a multilevel and multifaceted manner the key factors that influence adoption decisions. Drawing on 107 academic papers published between 1990 and 2023 as emerged from a systematic literature search, this study introduces a multilevel analytical framework that integrates intrinsic characteristics of concepts, individual, interpersonal, institutional and wider environmental influences, including professional norms, emotional reactions, organisational structures and the evolving “safety market” that ultimately drive adoption decisions. The key insights of the paper show that safety concepts are not merely adopted for safety improvement, and that adoption is not purely a rational or evidence-based process, but it is shaped by institutional isomorphism, affective dynamics, professional identity and norms.