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BMJ Qual Saf. 2017 Aug;26(8):632-640. doi: 10.1136/bmjqs-2016-006032. Epub 2016 Dec 22.

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.

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Duke Patient Safety Center, Duke University Health System, Durham, North Carolina, USA.
Department of Psychiatry, Duke University School of Medicine, Duke University Health System, Durham, North Carolina, USA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, North Carolina, USA.
Department of Pediatrics, Lucile Salter Packard Children's Hospital at Stanford, Palo Alto, California, USA.
Duke Hospital Medicine, Department of Medicine, Duke University Health System, Durham, North Carolina, USA.
Adventist Health, Roseville, California, USA.
The Sotile Center for Resilience, Davidson, North Carolina, USA.
Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, California, USA.



Improving the resiliency of healthcare workers is a national imperative, driven in part by healthcare workers having minimal exposure to the skills and culture to achieve work-life balance (WLB). Regardless of current policies, healthcare workers feel compelled to work more and take less time to recover from work. Satisfaction with WLB has been measured, as has work-life conflict, but how frequently healthcare workers engage in specific WLB behaviours is rarely assessed. Measurement of behaviours may have advantages over measurement of perceptions; behaviours more accurately reflect WLB and can be targeted by leaders for improvement.


1. To describe a novel survey scale for evaluating work-life climate based on specific behavioural frequencies in healthcare workers.2. To evaluate the scale's psychometric properties and provide benchmarking data from a large healthcare system.3. To investigate associations between work-life climate, teamwork climate and safety climate.


Cross-sectional survey study of US healthcare workers within a large healthcare system.


7923 of 9199 eligible healthcare workers across 325 work settings within 16 hospitals completed the survey in 2009 (86% response rate). The overall work-life climate scale internal consistency was Cronbach α=0.790. t-Tests of top versus bottom quartile work settings revealed that positive work-life climate was associated with better teamwork climate, safety climate and increased participation in safety leadership WalkRounds with feedback (p<0.001). Univariate analysis of variance demonstrated differences that varied significantly in WLB between healthcare worker role, hospitals and work setting.


The work-life climate scale exhibits strong psychometric properties, elicits results that vary widely by work setting, discriminates between positive and negative workplace norms, and aligns well with other culture constructs that have been found to correlate with clinical outcomes.


Safety culture; Surveys; Teamwork

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