77 CHAPTER IV CONCLUSION AND IMPLEMENTATION PLAN 1.1.Conclusion To conclude this study, findings related to the research questions are summarized in this chapter. • Determining level of burnout among physicians at Aceh tertiary and teaching hospital The current level of burnout at RSUDZA as Aceh tertiary and main teaching hospital determined through quantitative and qualitative data obtained from physicians in the hospital. The quantitative measurement of burnout was adapted from Oldenburg Burnout Index, which measures 2 major dimensions including exhaustion and disengagement dimension. According to the data gathered from 140 specialist physicians, the exhaustion dimension had an average score of 2,28, greater than the cut-off (2,25), indicating that the respondents experienced exhaustion. In addition, the mean score for disengagement dimension had an average score of 2,28, which was also greater than the cut off 2,1 that suggesting the physicians were disengaged to their work. Based on grouping analysis, 62,9% physician at RSUDZA fell in burnout group. In line with qualitative finding, 4 out of 5 physicians interviewed in this study said that they had experienced burnout at work. This was confirmed by the hospital management who stated that specialist physicians who worked at RSUDZA had experienced burnout at work. • Determining level of engagement among physicians at Aceh tertiary and main teaching hospital. Quantitative analysis of physicians’ engagement at RSUDZA was conducted using Utrecht Work Engagement Scale (UWES-9) that consist of three dimensions including vigor, dedication and absorption. All mean score for respective dimension fell into the average categories as followed: vigor (4,65), dedication (4,5) and absorption (4,58). In total, physicians’ engagement had an average score of 4,58 that can be concluded that physicians engagement in this study was categorized as average with the range of 2,89 – 4,99. From the triangulation analysis based on the qualitative data from face-to-face interviews 78 with physicians and hospital management concluded that physicians who work at RSUDZA were quite engage with their institution. • Proposing mono-loyalty practice at Aceh tertiary and teaching hospital based on burnout-engagement drivers. Strategy for proposing mono-loyalty practice at RSUDZA as Aceh tertiary and main teaching hospital started from assessment of key drivers from 7 burnout- engagement driver dimensions recommended by the Mayo Clinic including workload and job demands, control and flexibility, work-life integration, social support and community at work, organizational culture and values, efficiency and resources, and meaning in work. Based on triangulation analysis from quantitative and qualitative data, the selected burnout-engagement key drivers for proposing mono-loyalty practice in RSUDZA were (1) workload and job demands, (2) control and flexibility dan (3) organizational culture and value. Mono-loyalty practice implementation is potential to improve all of these key drivers with institutional resiliencies and individual resources in term of reducing burnout and promoting engagement among physicians. In addition, mono-loyalty practice implementation can promote focus at work that can bridge the connection between individual resources and institutional resiliencies through sharing of vision, communication improvement and the growing sense of belonging to their institution. 1.2.Implementation Plan Implementation start with socialization and discussion of the current burnout and engagement level based on the burnout-engagement assessment conducted in this study to the specialist physicians at RSUDZA. Hospital management must carry out a series of processes to create a resilience hospital related with burnout- engagement key drivers such as: create a positive work and learning environment, reduce administrative burden, enable technology solutions and implementation of comprehensive medication management.