Examining the pathways by which work-life balance influences safety culture among healthcare workers in Taiwan: path analysis of data from a cross-sectional survey on patient safety culture among hospital staff

Yvonne Tran, Hsun-Hsiang Liao*, En-Hui Yeh, Louise A. Ellis, Robyn Clay-Williams, Jeffrey Braithwaite

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Objective: The aim of this study is to examine the pathways by which work-life balance influences safety climate in hospital settings.

Design: A national cross-sectional survey on patient safety culture.

Settings: Healthcare workers from 56 hospitals in Taiwan, covering three work settings: intensive care units, operation rooms and emergency departments.

Participants: 14 345 healthcare workers took part in the survey and were included in the present analysis.

Primary and secondary outcomes measures: The Safety Attitudes, Maslach's Burn-out Inventory and Work-life balance questionnaires were used to measure patient safety culture, teamwork, leadership, emotional exhaustion and work-life balance. Path analysis was conducted to determine the relationship between work-life balance and safety climate. We tested for mediating and moderating factors influencing this relationship.

Results: The path between work-life balance and safety climate was found to be significant (b=0.32, p<0.001) and explained through a serial mediation. This relationship was found to be mediated by emotional exhaustion followed by teamwork climate in a full mediation. Leadership factors such as identifying as a manager, moderated the indirect pathway between work-life balance and safety climate through teamwork climate (index of moderation: b=0.083, bias corrected 95% CI 0.044 to 0.120) but not through emotional exhaustion or the serial pathway. Subgroup analysis from non-managers on their perception of management was also found to moderate this relationship.

Conclusion: We found work-life balance to be associated with safety climate through a fully mediated model. The mediation pathways are moderated by self-identified leadership and perceptions of leadership. Understanding the pathways on how work-life balance influences safety climate provides an explanatory model that can be used when designing effective interventions for implementation in system-based approaches to improve patient safety culture in hospital settings.

Original languageEnglish
Article number054143
Pages (from-to)1-8
Number of pages8
JournalBMJ Open
Volume11
Issue number11
DOIs
Publication statusPublished - 2 Nov 2021

Bibliographical note

Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • burnout
  • leadership
  • patient care management
  • patient safety
  • safety management
  • work-life balance

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