The Impact of High-performance Work Systems in Public Hospitals: Employee Empowerment, Patient Safety, Occupational Safety and Union Activities

The purpose of this study was to measure the effect of high-performance work systems (HPWS) on patient and employee safety, while examining the role of empowerment and union activities. This descriptive study was conducted in three training and research hospitals across three provinces in Türkiye. Data were collected via an online questionnaire using the HPWS, patient safety and employee safety surveys. Structural equation modelling (SEM) was applied for data analysis. Performance appraisal directly increases reporting frequency, while transformational leadership enhances managerial support for patient safety. Education, development and transformational leadership influence patient safety through structural empowerment, which also increases handoffs, transitions and reporting frequency. Psychological empowerment directly affects employee safety by improving compliance and participation in safety behaviours. Compensation impacts employee safety directly and patient safety indirectly through increased safety compliance. This study contributes to the understanding of how HPWS affects both patient and employee safety and emphasises the role of empowerment and union activities in a high-demand work environment.