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. 2019 Feb;28(2):142-150.
doi: 10.1136/bmjqs-2018-007933. Epub 2018 Oct 11.

Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis

Stephanie P Schwartz  1 , Kathryn C Adair  2 , Jonathan Bae  3 , Kyle J Rehder  4 , Tait D Shanafelt  5 , Jochen Profit  6 , J Bryan Sexton  2
Affiliations

Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis

Stephanie P Schwartz et al. BMJ Qual Saf. 2019 Feb.

Abstract

Background: Healthcare is approaching a tipping point as burnout and dissatisfaction with work-life integration (WLI) in healthcare workers continue to increase. A scale evaluating common behaviours as actionable examples of WLI was introduced to measure work-life balance.

Objectives: (1) Explore differences in WLI behaviours by role, specialty and other respondent demographics in a large healthcare system. (2) Evaluate the psychometric properties of the work-life climate scale, and the extent to which it acts like a climate, or group-level norm when used at the work setting level. (3) Explore associations between work-life climate and other healthcare climates including teamwork, safety and burnout.

Methods: Cross-sectional survey study completed in 2016 of US healthcare workers within a large academic healthcare system.

Results: 10 627 of 13 040 eligible healthcare workers across 440 work settings within seven entities of a large healthcare system (81% response rate) completed the routine safety culture survey. The overall work-life climate scale internal consistency was α=0.830. WLI varied significantly among healthcare worker role, length of time in specialty and work setting. Random effects analyses of variance for the work-life climate scale revealed significant between-work setting and within-work setting variance and intraclass correlations reflected clustering at the work setting level. T-tests of top versus bottom WLI quartile work settings revealed that positive work-life climate was associated with better teamwork and safety climates, as well as lower personal burnout and burnout climate (p<0.001).

Conclusion: Problems with WLI are common in healthcare workers and differ significantly based on position and time in specialty. Although typically thought of as an individual difference variable, WLI appears to operate as a climate, and is consistently associated with better safety culture norms.

Keywords: burnout; safety climate; safety culture; scale; survey; teamwork climate; work-life balance; work-life integration.

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Conflict of interest statement

Competing interests: SCORE is available at no cost for research and quality improvement purposes. The Duke Patient Safety Center has a research contract with Safe & Reliable Healthcare to conduct secondary analysis on Safety Culture data. Safe & Reliable Healthcare uses the work-life climate scale in their online platform. TDS is coinventor of the Physician Well-Being Index, Medical Student Well-Being Index, Nurse Well-Being Index and Well-Being Index. Mayo Clinic holds the copyright for this instrument and has licensed it for use outside of Mayo Clinic. TDS receives a portion of any royalties paid to Mayo Clinic. TDS has received honorarium for presenting grand rounds, keynote lectures and advising on the topic of physician well-being. JBS and JP have funding through the NIH through a WISER R01 grant (R01 HD084679-01) to study burnout in healthcare. KCA and JBS have received honorarium for talks in which they discuss WLI and burnout.

Figures

Figure 1
Figure 1
Good work-life climate or percent positive is defined by those who reported performing the specific poor work-life balance (WLB) behaviours 1–2 days/week or less than 1 day/week. Graph (A) shows the percentage of respondents reporting good work-life climate by each clinical work setting. Graph (B) shows percentage of respondents reporting good work-life integration (WLI) by healthcare worker role. Graph (C) shows the percentage of respondents reporting good WLI by length of time in specialty and shift type and length.
Figure 2
Figure 2
Differences between teamwork climate, safety climate, burnout, personal burnout, local leadership and improvement readiness between work settings divided into work-life climate (WLC) quartiles. Each bar is the mean of the percent positive responses for each work setting within a quartile.
See this image and copyright information in PMC

References

    1. Sexton JB, Schwartz SP, Chadwick WA, et al. The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions. BMJ Qual Saf 2017;26:632–40. 10.1136/bmjqs-2016-006032 - DOI - PMC - PubMed
    1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in and satisfaction balance in physicians and the general US population between 2011 and 2014. Mayo Clin Proc 2015;90:1600–13. 10.1016/j.mayocp.2015.08.023 - DOI - PubMed
    1. Kavalieratos D, Siconolfi DE, Steinhauser KE, et al. "It Is Like Heart Failure. It Is Chronic … and You": A qualitative analysis of burnout among hospice and palliative care clinicians. J Pain Symptom Manage 2017;53:901–10. 10.1016/j.jpainsymman.2016.12.337 - DOI - PMC - PubMed
    1. Ahola K, Väänänen A, Koskinen A, et al. Burnout as a predictor of all-cause mortality among industrial employees: a 10-year prospective register-linkage study. J Psychosom Res 2010;69:51–7. 10.1016/j.jpsychores.2010.01.002 - DOI - PubMed
    1. Shanafelt TD, Boone SL, Dyrbye LN, et al. The medical marriage: a national survey of the spouses/partners of US physicians. Mayo Clin Proc 2013;88:216–25. 10.1016/j.mayocp.2012.11.021 - DOI - PubMed

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