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

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 outcome 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.

Keywords: burnout; leadership; patient care management; patient safety; safety management; work-life balance.

Figure 1

Hypothesised serial mediation model for work–life balance (WLB) and safety climate (SC) with leadership moderators. The direct relationship was between WLB and SC. The indirect relationships were: (1) WLB->emotional exhaustion (EE)->SC; (2) WLB->teamwork climate (TC) ->SC and (3) WLB>EE>TC>SC. Pathways are hereinafter expressed in abbreviated form (eg, WLB>EE> SC).

Figure 2

Serial mediation pathway for work–life balance and safety climate with regression coefficients (B). ***P<0.001. NS, not significant.