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The healthcare employer that becomes active in reducing burnout and improving work environmental health becomes the "employer of choice" – demonstrating corporate social responsibility to the community, staff and patients, increasing added value to stakeholders and shareholders. Chronic unaddressed disruptive behavior and lower morale resulting from stress and/or burnout makes physician engagement especially challenging. These factors translate through the organization with ultimately adverse interfaces with colleagues and patients. Organizations who promote safety and quality among other core values must confront and effectively address work related causes for stress and burnout using both preventive and mitigation measures.[43] Progressive organizations will proactively intervene by systematically providing organizational sponsored initiatives to support the unique aspects of physician work/life balance. Organizations could improve needed business alignments and coordination to realize their stated missions in healthcare. 4.4 The legal case Healthcare systems need to demonstrate due diligence to physicians, staff, the patient’s they serve who are at risk as well as to the stakeholders and shareholders. Case law provides a legal basis to support claims that particular types of stress at certain levels are hazards under health and safety rules. Employers have a duty to abate such foreseeable hazards at the source under general requirements of due diligence.[60] 5 Possible solutions Solutions are in the realms of both organizational and individual solutions. Collaboration among, or awareness of national, state and local forces that affect physician work flow and work load is logically necessary to be capable of making an informed risk/benefit assessment of proposed healthcare initiatives. Healthcare decision-makers must assess potential unintended consequences before mandating new health care initiatives. Those that actually deliver healthcare must be at the design table with system based, local state and national leadership to protect against future unintended negative consequences. Ongoing two-way communication between designers and implementers must be built in to initiatives to allow course corrections if needed. Many current initiatives in healthcare reform are using financial incentives or punitive methods. Alternatives to coercion should be explored in shaping the healthcare system. Positive Behavior Support (PBS) helps improve desired behaviors integrating certain key concepts: • People don’t control others but support others in the change process • There is a conviction to continually move away from coercion • It is effective to try to understand the reason for problem behaviors • Showing dignity and respect is always important • Applied behavioral science can positively affect valued behaviors in healthcare[61] Hospitals and healthcare systems can reduce stress on physicians by centrally taking on the responsibility to assist physicians with administrative support necessary to streamline the accomplishment of mandates and regulations (reduces extraneous cognitive load). This would require a shift in culture from individual physician responsibility to find the time to comply with mandates needed to do their job, to a healthcare system complying as an organization by assisting its doctors to reduce this administrative extraneous cognitive load. This may not require additional funds, but realignment of responsibilities of support staff. If additional funds are required, they can be justified as investment to reduce physician leakage costs, malpractice costs, healthcare costs etc. Leadership commitment to action is key. Gaining back the trust of physicians and staff and sending a message that their welfare is cared about takes consistency, transparency and action. An anonymous survey helps gather needed site specific data. Inquiry should include the positives and the stressors of work environment with request for actionable solutions in the setting of limited finances. Results should be shared with physicians and staff in a timely way to rebuild trust through transparency.
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