Effects of spillover, boundary management, and social norms on employees’ work-life balance in national referral hospitals in Kampala, Uganda

Abstract

Healthcare workers (HCWs) in Uganda’s national referral hospitals struggle to achieve work-life balance (WLB) due to heavy workloads, workforce shortages, and limited supportive policies, leading to high stress levels and low job satisfaction. Globally HCWs face burnout from poor WLB, a challenge worsened in sub-Saharan Africa by staffing deficits. In Uganda, 46% of HCWs consider relocation due to burnout and poor conditions, while Kampala’s referral hospitals, handling high patient loads (e.g., 90-120 births monthly with nurse-to-patient ratios exceeding 1:100), provide a critical context for studying WLB dynamics. Existing research focuses narrowly on family-related spillover, overlooking broader dimensions (affect, behavior, values), while other studies focused on identifying factors contributing to positive spillover rather than establishing a causal link between spillover and employee work-life balance. Additionally, some studies on boundary management only looked at one dimension of boundary management (work-family segmentation) thereby overlooking other constructs like work-life integration and boundary control while other studies focused on how people manage boundaries between work and personal life without establishing the causal relationship between boundary management and work-life balance. Moreover, studies that focus on social norms focus on isolated aspects of social norms such as work values or gender roles without integrating critical dimensions of social norms such as social responsibility, agreeableness, and social desirability. Therefore, the purpose of the study was to examine how spillover effects, boundary management, and social norms collectively influence WLB among HCWs in Kampala’s referral hospitals, offering insights for policy and workplace interventions. Using a correlational design within a positivist framework, grounded in spillover, work-family border, and cultural-historical activity theories, the study surveyed a stratified random sample of 352 HCWs from a population of 2,914. Validated questionnaires (content validity: 0.900, 0.913; reliability: 0.717, 0.897) were analyzed with descriptive statistics and multiple regression, revealing a strong relationship between predictors and WLB (R = 0.883, R² = 0.780). Social norms (β = 0.641, p < 0.001) and boundary management (β = 0.528, p < 0.001) positively influenced WLB, while spillover had a negative impact (β = -0.255, p < 0.001). These findings, reflecting challenges like 57.4% of HCWs experiencing workload-driven stress and 43.3% intending to leave within six months, highlight the need for targeted interventions. Recommended strategies include flexible scheduling, boundary management training, regular WLB audits, and institutionalizing WLB metrics to address dissatisfaction and reduce turnover intentions. By providing research-backed solutions, this study informs human resource policies in Uganda’s healthcare sector and similar high-pressure settings globally, enhancing employee well-being and mitigating burnout. The study recommends hospitals to implement after-hours communication protocols, mandatory recovery periods, and emotional decompression programs. Boundary management should be prioritized through workflow redesign, and scheduling autonomy tools. Social norms require cultural transformation via leadership modeling.