Chronic Occupational Stress and Decision-Making Capacity in Healthcare Administrators: A Narrative Review of HPA Axis and Prefrontal Cortex Mechanisms

Healthcare administrators often work under chronic stress. Regulatory pressures, economic imperatives, understaffing—the decisions pile up daily. The behavioral consequences of this occupational stress are well documented: burnout, emotional exhaustion, depersonalization, among others. These phenomena are widely reported in literature on healthcare management. What is missing from this body of literature is an understanding of the mechanisms underlying the decrease in quality of decision-making owing to chronic occupational stress. This paper reviews the literature of neuroendocrinology and cognitive neuroscience in the context of extant healthcare management research to develop this understanding. It examines the chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis, subsequent dysregulation of cortisol secretion, and the effects on functioning in the prefrontal cortex related to working memory, cognitive flexibility, and inhibition as studied in both animals and humans. The paper links these to decision-making abilities of healthcare administrative leaders. The research methodology for this study includes experimental stress research, an extensive literature review on drug intervention in the HPA axis, survey research, and grounded theory from interviews with healthcare administrators. The final chapter contains the organizational implications and recommendations for further research.