The Relationship between Role Clarity and Psychological Safety in the Healthcare Sector in Saudi Arabia: A Mixed-Methods Research Study

Abstract

The aim of this thesis was to examine the relationship between role clarity and psychological safety in Saudi Arabia’s healthcare sector during the Health Sector Transformation Program (HSTP), and explored their combined influence on employee well-being. A pragmatic paradigm and concurrent mixed-methods design were adopted. The quantitative study was based on a survey of 270 healthcare employees using validated instruments, while the qualitative study involved 33 semi-structured interviews exploring employees’ experiences of clarity and safety during reform. Data were analysed through multivariate regression and mediation models for the quantitative study, and thematic analysis for the qualitative study, with integration at the interpretation stage. Quantitative findings showed that role clarity was significantly associated with psychological safety at individual, team, and organisational levels. Role clarity was also related to well-being, with team psychological safety partially mediating this association. Leadership role showed a small effect, but tenure and employment status were not significant. Qualitative findings revealed how inclusive leadership, recognition, and clear communication fostered psychological safety, while reform-related ambiguity, shifting responsibilities, and reliance on informal channels undermined it. Hierarchical and cultural dynamics influenced whose voices were heard, with lower-status staff more hesitant to speak up. The integration of findings demonstrated that role clarity is a crucial job resource that supports psychological safety and well-being, but its benefits are amplified in supportive team climates. Using the Job Demands-Resources model, Status Characteristics Theory, and the Readiness for Change framework, the study showed how organisational, relational, and contextual factors interact to shape outcomes. The thesis provides empirical evidence of the clarity-safety-well-being relationship, refines theoretical frameworks by emphasising their interactive and contingent nature, and offers context-specific insights from a reforming, non-Western healthcare system. Findings have practical implications for leadership development, role design, and communication strategies during organisational transformation.