Engage Administrative offices of Risk Management, Patient Safety and Quality, Medical Staff Office, Compliance, Wellness, Human Resources, Medical Executive Committee and Communication Office to keep all aware of processes.

1. Evaluate processes, polices and metrics currently in place

Are they strategic (why)?

Are they necessary (why)?

What might be the unintended consequences? (Note: administrative leadership would make more informed decisions if they have foundational knowledge of multiple are of impact of burnout)

In the context of meeting requirements, is there a better way to not drain highly trained clinician time and brain (neural) resource?

Understand clearly what a regulatory requirement specifies. Look up the written requirement.

Satisfice-satisfactory and sufficient to meet the requirement but no locally added extras.

Can make additional information available for voluntary education or for use to be called up for use in future relevant clinical situations as a clinical resource.

Create a clearing house for all mandatory requirements that senior leadership be made aware of and a mechanism to manage the total mandatory load on clinicians espoused by multiple administrative offices.

Job-Resource model of burnout [55] . When cognitive jobs go up, resources need to also go up to avoid burnout and error. Job-related requirements must be a cost of doing business for the organization. This creates a business-related force to be most efficient and time conscious of clinician time as to what must be mandatory and what can be voluntary.

2. Standardization

What are the core operational processes to standardize and promote routines? When should you allow and encourage aligned autonomy or customization?

Are there opportunities to standardize and simplify layout locations of core functions of care of patients throughout the institution?

Can clinical unit design be standardized (with collaboration of clinicians with architects) to make easier to find what is needed easily regardless of unit worked?

Consider when standardization might jeopardize safety or not meet a patient’s unique needs.

Are there options for “wiggle room” built in?

Decision to engage most’ wiggle room” options should be under the control of the clinician, but consider when variation might require the authorization of a superior.

3. Consolidate information

Reduce split attention effect. Separated information requires more brain (neural) resource to cognitively process than physically integrated information.

Be user-centric-design groupings of information by what works best for the user.

Keep wording to key information so it can be processed by working memory. Finer detail can be pursued by interest or wish to understand more fully after essentials are understood.

Process Coupling. Workflow processes related to each other should be made physically closer together for ease and simplicity of operations.

4. Decrease redundancy. Redundancies are extra elements not absolutely necessary for understanding or functioning.

In communication of data and design. Irrelevant information clogs up the working memory which transfers information to long term memory. Hence clogging may contribute to forgetting.

Be concise

Be precise

Use emphasis strategically

5. Prioritize design

Equipment and layouts should have deliberate designs that consider human limitations.

Anticipate situations of clinician low cognitive resources, such as occur in burnout, high stress, high volume demand, evening or night shift, extended work hours, sleep and food deprivation.

Over-complexity in design will require high cognitive resources. Keep in mind the competing factors for clinician’s attention and potential cognitive processing state affected by situations of low cognitive resource.

6. Leadership Collaboration

Among all leaders who roll out requirements and work expectations

Collaboration with clinicians, encouraging participatory management, input from those most familiar with the work to be done.

Understand how work-as-imagined compares to total real work done.

Be aware of shadow work (work off metrics, unseen, unpaid but fill the day) and Work Outside of Work (WOW).

Find opportunities to lower total institutional Extraneous Cognitive Load (ECL) by means of the multi-administrative office collaboration.

Work with Human Factors/Ergonomics professionals. Hire them at your institution.

Consider collaboration of HFE professionals with Lean professionals, as HFE science will help both prevent future and mitigate existing risk areas. HFE “waste” to be reduced or eliminated is predominantly ECL. Lean processes are well known in hospitals and can be harnessed to achieve reduction of ECL burden.

Job-resource model of burnout [55] . Table adapted and expanded from [10] .