5. Protect mental safety

Workplace harm is not bad luck. Mental harm at work is not inevitable - it reflects governance and system failures that expose doctors to unmanaged psychosocial hazards, increasing the risk of patient complaints, clinical incidents and compensable work-related mental injury. It is predictable, preventable and can be optimally managed. 

Preventing and managing psychosocial hazards protects health and safety, reduces turnover and absenteeism, and improves performance and retention.

The Work Health and Safety (Managing Psychosocial Hazards at Work) Code of Practice was registered on the Federal Register of Legislation in late 2024. Your employer now has a legal duty to put in place systems, procedures and policies to prevent, reduce and manage the impact of psychosocial hazards that predispose all employees (eg. doctors in training), contractors (eg. GPs) and visiting consultants to mental injury, including:

1. Common hazards under the Code
2. Intense work stress 
3. Damaging interpersonal conflict
4. Unconscious and conscious bias
5. Other negative behaviours

1. Common hazards under the Code

Under the Model Code of Practice, employers must identify, assess and control the following psychosocial hazards:

A. Excessive job demands
B. Low job control
C. Poor support
D. Lack of role clarity
E. Poor organisational change management
F. Inadequate reward and recognition
G. Poor organisational justice
H. Exposure to traumatic events or material
I. Remote or isolated work
J. Poor physical environment
K. Conflict or poor workplace relationships

Excessive job demands involve sustained physical, mental or emotional effort and become hazardous when prolonged. Risks include excessive over time hours, heavy workloads and unreasonable doctor - patient ratios, and expecting a doctor to perform tasks and procedures outside their scope of training. Controls include preplanning of realistic staffing levels and workload, protected breaks, optimal training and supervision, emotional support after exposure to trauma.

Low job control occurs when autonomy is restricted, such as rigid rosters or unnecessary approvals. Risk is reduced by flexibility, shared planning, and control over task timing and priorities.

Poor support includes lack of resources, poor communication, unavailable supervisors or toxic cultures. Control measures include resourcing, supervisor training, clear escalation pathways and teamwork.

Lack of role clarity arises from unclear expectations, shifting duties or ambiguous reporting lines. Risk is reduced through clear role descriptions, instructions and accountability structures.

Inadequate reward and recognition become hazardous when effort is persistently unacknowledged. Controls include meaningful feedback, fair evaluation, development opportunities and respectful management.

Poor organisational justice reflects unfair processes, inconsistent decision-making, lack of transparency or blame cultures. Risk is managed through fairness, privacy, consistency and respectful communication.

Exposure to trauma becomes hazardous when frequent or severe. Controls include limiting exposure, role rotation, protected recovery time, debriefing and trauma-informed responses.

Poor physical environments affect safety and concentration. Risks include unsafe tasks, poor equipment, ill-fitting PPE, poor air quality and inadequate facilities. These must be addressed in line with WHS standards.

More information:
Safe Work Australia – Model Code of Practice: Managing Psychosocial Hazards at Work
https://www.safeworkaustralia.gov.au/sites/default/files/2022-08/model_code_of_practice_-_managing_psychosocial_hazards_at_work_25082022_0.pdf
https://www.safeworkaustralia.gov.au/safety-topic/managing-health-and-safety/mental-health/psychosocial-hazards

2. Intense work stress

Doctors work in high-stakes environments - making rapid decisions, managing crises, and being exposed to trauma, grief and uncertainty. These pressures are amplified by community expectations that doctors are always competent, caring and available. 

Patient complaints, processes to manage clinical incidents and medicolegal issues also create intense stress for doctors, particularly if unreasonable, prolonged or malicious. Doctors targeted by vexatious complainants need experienced collegial, organisational and psychological support.

Stress also accumulates from personal life events - career transitions, relationships, parenting, illness or loss. Together, these pressures compound overall strain.

Helpful strategies may include:

• Confront concerns: write worries down; acknowledge emotions
• Accept limits: focus on what you can influence
• Create mental distance: try to disconnect during breaks
• Allow recovery: seek support and practise self-compassion

If ruminating about work persists, try to ask:

• What is the evidence for this belief?
• Is there another explanation?
• What is the worst, best and most realistic outcome?
• What would I advise a colleague?

Evidence-based tools include Cognitive Behavioural Therapy techniques, positive psychology, mindfulness and relaxation.

Sleep disruption is common in doctors, particularly with shift work. Generic sleep hygiene may be insufficient. Non-pharmacological programs such as The Mindful Way to Healthy Sleep (www.amindfulway.com.au) offer tailored approaches for clinicians.

For more information about managing intense stress, refer to Topics 7, 10 and 12. 

3. Damaging interpersonal conflict

Respectful disagreement and robust debate are essential for ongoing learning, discussing ethical dilemmas and maintaining patient quality and safety. Conflict becomes harmful when ego driven, unmanaged or personalised.

When conflict arises:
A. Set ego aside and view it as a chance to strengthen relationships
B. Stay calm and assertive
C. Start positively (“I value your standards…”)
D. Clarify facts to avoid misinterpretation
E. Listen actively and seek examples
F. Acknowledge perspectives
G. Generate and evaluate solutions together
H. Review outcomes later

If emotions escalate, use “I” statements, address behaviour not character, and consider mediation if needed.

Reflect on past conflicts: did authority, tone or past experiences influence your response? Experiment with remaining professional, calm and persistent in future interactions.

For more information please refer to Every Doctor: healthier doctors=healthier patients in Topic 12. 

4. Unconscious and conscious bias

In a workplace context, bias refers to the mental shortcuts we all use to make rapid judgements about people, situations and risk. These shortcuts are normal and often efficient. However, in complex, safety-critical environments such as health care, they can influence decisions about recruitment, supervision, performance assessment, complaint handling and incident review in ways that create risk for both clinicians and patients.

Conscious bias is deliberate, aware and intentional. It occurs when a person knowingly holds attitudes, beliefs or preferences about a group and allows these views to influence behaviour or decision-making. 

Unconscious bias is automatic, unintentional and operates outside conscious awareness. It arises from learned associations formed over time through training, culture, media and institutional norms. Importantly, unconscious bias can influence perception, memory, credibility judgements and decision-making even when individuals consciously endorse fairness and equity.

Workplace examples include:

• Interpreting identical assertive behaviour as “leadership” in a male intern but “abrasiveness” in a female intern.
• Being more likely to trust, mentor or support someone who reminds      you of yourself.
• Assuming a quiet doctor in training is less capable or engaged.

In clinical environments, unconscious bias may affect whose concerns are taken seriously, who is labelled “resilient” versus “struggling”, who is offered informal support, and who is blamed when system pressures contribute to adverse outcomes.

Both conscious and unconscious bias can:

• undermine psychological safety,
• contribute to discrimination and workplace harm,
• distort performance management and complaints processes,
• and increase the risk of scapegoating individuals for system-level failures.

Where biased decision-making contributes to unsafe working conditions or prevents staff from raising concerns, it may expose organisations and their officers, including boards and senior clinicians, to legal risk.

Practical steps to overcome bias:

• Value all voices
• Challenge stereotypes
• Focus on competence, not appearance
• Call out disrespectful language
• Recognise cumulative harm from “small” comments

5. Negative behaviours

For more information about workplace hazards such as discrimination, racism, sexual harassment, bullying and any form of violence are covered under Topic 6. 

Poorly handled processes for managing negative behaviours can worsen harm - particularly when victims and perpetrators are forced into inappropriate mediation. Early, confidential escalation to a trusted senior person can prompt change and protect others. For more information refer to Topic 9.

Culture matters in addressing negative behaviours. A strong speak-up culture, visible leadership and anonymous reporting mechanisms reduce hazards and harm.

For further information, the 2nd edition of the book Every Doctor: healthier doctors = healthier patients co-authored by Dr Leanne Rowe and published by Taylor and Francis is available via Booktopia. See Topic 12.