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.

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.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)