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


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.





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Publication Info

Schwartz, Stephanie P, Kathryn C Adair, Jonathan Bae, Kyle J Rehder, Tait D Shanafelt, Jochen Profit and J Bryan Sexton (2019). Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: a cross-sectional survey analysis. BMJ quality & safety, 28(2). pp. 142–150. 10.1136/bmjqs-2018-007933 Retrieved from

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Jonathan Gregory Bae

Associate Professor of Medicine

Patient safety and quality improvement, hospital based performance improvement, care transitions and hospital readmissions, general internal medicine hospital care, resident and medical student education.


Kyle Jason Rehder

Dr. Glenn A. Kiser and Eltha Muriel Kiser Professor of Pediatrics

Mechanical Ventilation, ECMO, Patient Safety and Quality, Communication, Education


John Bryan Sexton

Associate Professor in Psychiatry and Behavioral Sciences

Bryan is the Director of the Duke Center for the Advancement of Well-being Science.  He leads the efforts around research, training and coaching, guiding quality improvement and well-being activities.  


A psychologist member of the Department of Psychiatry, Bryan is a psychometrician and spends time developing methods of assessing and improving safety culture, teamwork, leadership and especially work-force well-being.  Currently, he is disseminating the results from a successful NIH R01 grant that used RCTs to show that we can cause enduring improvements in healthcare worker well-being. 


A perpetually recovering father of four, he enjoys running, using hand tools on wood, books on Audible, and hearing particularly good explanations of extremely complicated topics.

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