Canadian family physician Franklin Warsh had a problem. At work, he was “groaning about patients that created minor nuisances” and, when he got home, he was “reaching for a drink” instead of love from his wife and kids. He saw “no value” in his job.
“One tantrum later,” Warsh declared, “I gave my notice”.
Warsh’s story resonates across many industries, but especially with healthcare workers. The symptoms he described are attributable to “burnout”, a term coined in the 1970s but only adopted by the World Health Organization (WHO) in 2019.
A syndrome conceptualized as “resulting from chronic workplace stress that has not been successfully managed”, burnout sufferers exhibit low energy levels and exhaustion. They often feel isolated from their job and can suffer from compassion fatigue — cynical, negative feelings about their work. Those afflicted often become unable to respond to excessive demands of the job, leading to a drop in productivity and output, as well as a feeling of being devalued.
The WHO does not classify burnout as a medical condition, but as an occupational phenomenon. This distinction draws an important link: burnout is inherently tied to the workplace, and implicitly seems to be onset by poorly managed professional stress.
The pandemic has left a vast majority of healthcare workers feeling burnt out. Pre-pandemic, somewhere between 11 percent to as many as one-third of healthcare workers could be defined as “burnt out”. During the pandemic, a 2020 online survey of Australian frontline healthcare workers found that over 70 percent of the 7800 respondents were burnt out. The focus has been on individuals in early proposals to treat burnout, examining personality traits and how that may have contributed to the risk of the syndrome. The proposed fix was building individual resilience to workplace stressors, and seemingly overnight an industry of training courses, books and workplace interventions sprung up.
These strategies are only addressing part of the issue and proving insufficient. They may even be causing more harm, blaming the individual for their reaction to stress rather than challenging employers to better prevent or mitigate the stressful environment.Shifting the burden to healthcare employers — the more influential, better resourced party in the equation — could unlock new avenues to address burnout. Employers have the means and capacity to holistically target burnout prevention and mitigation. There are broadly six relevant domains that organizations could consider to prevent burnout in their staff.
Workload
Adequate staffing is an immediate intervention to address burnout, but doing so is a multifaceted fix. Funding to train, employ and roster enough employees around the clock requires major investment, but would likely pay dividends in reducing burnout. And beyond having an appropriate amount of staff on shift at any given point, maintaining a healthy reserve of additional employees to tap into when required — such as covering for illness — would help ease the strain.
But burnout isn’t just about the number of employees in the room. Creating systems that give line managers clear visibility of each staff member’s workload would make it easier to react and respond when problems arise.
Part of that is keeping shifts within the agreed parameters. Healthcare employers can intervene to prevent overworking by eliminating compulsory overtime, encouraging better adherence to correct start and finish times, and limiting out-of-hours contact with employees, either as a company policy or by encouraging employees to switch off their work phones when not on shift.
Control over workload
Workers who are empowered by their employer to manage their own workload may be less likely to experience burnout. This starts with each staff member having clarity over their role, and being presented opportunities to discuss their work demands with a line manager.
Autonomy over how to undertake work tasks where possible can help employees. Offering choices over how tasks are shared and prioritized, as well as the timing of breaks, embeds flexibility in a work day. Delegating responsibilities and investing trust in appropriately-trained staff, such as allowing their influence over work patterns and vacation schedules, are more measures that can promote a culture of sharing responsibilities within a team.
With these freedoms, employees who are encouraged to take rostered breaks and use holiday leave may be less likely to get burned out and feel more supported in their workplace.
Reward and appreciation
Paying employees more is an intuitive way to address burnout, even if it doesn’t resolve everything. Giving staff more opportunities for professional development and pathways to not only get paid more for the work they already do, but step into higher roles that offer a pay bump, is a way to mitigate the feeling of grind that characterizes some cases of burnout.
But the reward has to go further than the figure at the bottom of the paycheque — intrinsic reward, such as acknowledging effort and good work — matters, too. And showing an appreciation for staff by granting them a range of leave options, such as volunteering leave and cultural holidays, is likely to contribute to a healthier work environment.
A healthy workforce is likely to be more resilient to burnout. Encouraging and facilitating good lifestyle choices — promoting cleaner eating and exercise by making it accessible, such as providing complimentary healthy snacks at work or subsiding gym memberships, is a way that employees can show support for healthcare workers.
Making mental health resources accessible, such as providing free confidential counselling, and fostering a culture that de-stigmatizes seeking help would likely help reduce burnout. If employees are able to seek help before, or as, burnout becomes an issue, it could alleviate the phenomenon.
Sense of community
Employees tend to be less burnt out if they feel their workplace is a community of friends and allies. Employers have the power to make or break a culture. Facilitating relationships between staff through initiatives that promote supportive, effective and transparent team-working can help set the groundwork for future friendships, and thinking carefully about healthcare developments to avoid dividing or isolating a team can help prevent adversarial pitfalls arising.
For instance, radiologists and patients have benefited from the efficiency of improved electronic reporting systems, but the advancements have come at a tradeoff — radiologists can now perform their role 100 percent electronically without need for consultation with a wider healthcare team, isolating them from colleagues. Those managing radiologists in these situations could be mindful to find other avenues in which to integrate them, socially or professionally, with other employees to lower the chance of burnout.
Underpinning a preventive culture are clear, strong lines of communication — employees feeling like they can hear and be heard without inhibition.
Fairness and justice
Conflict resolution in the workplace can be a quagmire to navigate, but ensuring it is based on strong principles can reassure employees that any concerns that arise will be dealt with appropriately. An environment in which all workers feel treated the same, where issues are dealt with transparently, and there are reliably strong procedures to dispense justice, is likely to be one in which employees are better able to avoid burnout.
Organizational values
Coalescing many of the other domains into a mission statement of sorts from the employer solidifies a strong culture. Making everyone feel like they matter, prioritizing meaningful work and doing so with effective, supportive leadership is at the heart of creating a workplace big on preventing burnout. If employees feel like they have a voice, flexibility within their work and a balance with their life outside of work, they are far less likely to suffer the symptoms of burnout. Leadership plays a two-sided role — not only in expressly encouraging a work-life balance verbally and through policy, but modelling it: taking breaks and holidays themselves, and restricting contact with employees out-of-hours.
(Karen Walker-Bone is Head of the Monash Centre for Occupational and Environmental Health and Professor of Occupational Rheumatology. She leads research to enable healthy work participation for all)
