Duty to Reduce Uncontrollable Stress in Healthcare Workers. Help Is on the Way

Abstract

Objectives: To advise policy makers, law and administrative practitioners of the new science of physical injury to the brain of healthcare workers (HCWs) due to uncontrollable but not controllable occupational stress. Leaders have the potential and the means to affect the controllability of occupational stress on HCWs. Many resources and guides to do so are in the public domain. Without leadership interventions, the occupational stress remains uncontrollable. OSHA requires employers to provide a workplace free from recognized hazards likely to cause death or serious physical harm. New medical/neurologic findings now raise moral and legal duties for employers to protect healthcare workers from such hazards as uncontrollable occupational stress. Methods: Literature focused upon recent studies that outline severe neurological and medical impact from uncontrollable stress is supported by functional MRI studies and SPECT Scans. We reviewed existing policies, causes of uncontrollable stress on HCWs that exist in the current healthcare delivery environment and known interventions that healthcare leadership can perform to reduce uncontrollable stress by its volume reduction and especially allowing more HCW decisional latitude and participation to influence its reduction. We propose legal theories to incorporate these new findings, as seen in international practices. This process described was undertaken by an interprofessional collaboration of physicians, attorneys and healthcare economists resulting in conclusions and recommendations. Results: Current HCW work environments are characterized by uncontrollable stress manifested by little ability to escape from or influence mitigation of that stress. Leaders of healthcare work environments are in the prime position to reduce the factors that create uncontrollable stress conditions, thereby enabling HCWs psychological safety for feedback, opportunity to influence their work environment, express ideas for improvement, as well as allowing more options for choice in fulfilling their duties. HCW’s uncontrollable stress conditions in their work environment replicate conditions of brain injury and medical sequelae. Burnout is prevalent, well known to be a significant problem in healthcare and is foreseeable. Findings now approach, and likely meet, criteria for the legal standard of a recognized hazard. There are existing methods of recognition and detectability where the impact of HCWs’ uncontrollable stress meets the severity threshold, and there is feasibility of and existing guidance for abatement. Thus, the regulatory and legal risk attached to these issues is currently underappreciated and only likely to increase. National professional organizations recommend interventions in the public domain to reduce burnout and stress. However, healthcare facilities currently view these actions as voluntary. Healthcare workforce leadership have a duty to protect their HCWs and hence their patient constituents from this uncontrollable occupational stress. We must robustly apply organizational methodologies to reduce this stress and improve HCWs health and wellbeing, which ultimately influences patient outcomes. Conclusions : We recommend a focus on engagement of adequate resources and processes via healthcare leadership, as well as awareness and involvement to improve such work conditions. Moral, legal, ethical, patient safety and financial duties exist to command the reduction of uncontrollable stress on HCWs. We recommend Hospital and other healthcare General Counsel advise their CEO and senior leadership about this duty to protect their HCWs and their patients from the impact of uncontrollable stress.