Safety leading indicators have been investigated as a proactive management approach to managing construction safety. However, there is a lack of insight into the implementation of safety leading indicators in construction projects and organizations. This causes difficulties in the adoption and consistent use of safety leading indicators in the construction industry. The aim of the research is to explore what and how safety leading indicators can be implemented to improve safety management in the construction industry. Built upon Xu et al. (2021), the study prioritized the relative importance of 17 safety leading indicators through a three-round Delphi survey and voting analytic hierarchy process (VAHP). It was found that organization commitment; client, designer and contractor engagement; training and orientation; safety climate and competence were most critical to safety performance in construction. Furthermore, operational, organizational and strategic barriers to the effective implementation of safety leading indicators were identified through the focus group discussion. The study suggested strategies for addressing these barriers and moving toward a proactive safety management approach. This study contributes to the theories and practices of construction safety management by linking the deployment of safety leading indicators with organizational and strategic issues at firm and project levels and addressing the root causes of poor performance. The effective deployment of safety leading indicators needs the engagement of clients, contractors, designers and supply chains to develop organizational capabilities to drive improvements from the project front-end to completion.