Abstract
In the chapter on “factors influencing health status,” the 11th Revision of the International Classification of Diseases updated the definition of burnout to an occupational phenomenon caused by chronic workplace stress that is characterized by exhaustion, cynicism, and reduced professional efficacy. 1,2
Affecting health status indeed. A review of 36 studies reported that burnout was a significant predictor of several adverse physical and psychological conditions and outcomes, including high cholesterol, type 2 diabetes, coronary heart disease, pain, fatigue, headaches, gastrointestinal issues, respiratory problems, severe injuries and mortality among those under 45 years old, insomnia, depressive symptoms, use of antidepressant medications, and inpatient psychiatric hospitalizations. 3 The economic toll of burnout has been estimated to be as high as $190 million annually in health-care costs. 4 Those figures aren’t reflective of the total costs to individuals or organizations as they don’t include job dissatisfaction, absenteeism, presenteeism, 3 or turnover. Houston, we have a serious problem.
In light of the significance and magnitude of the problem, many interventions have been deployed to address burnout, including yoga, 5 cognitive behavior therapy, 5 -7 mindfulness, 5,8 company-wide book clubs, 9,10 and reminders to focus on the positives. 8
However, as Jennifer Moss and Amaryllis Sánchez Wohlever so aptly explain, individual-level interventions to address burnout will not be sufficient. Their position is supported by a recent systematic review 11 of burnout interventions that underscores the importance of combining individual- and organizational-level interventions. Many experts argue that the workplace itself is, in fact, the bigger lever to pull. 9,12 Employers simply must look inward to examine and address the organizational factors that are key contributors to burnout. 4,13,14
Employers can play a big role in addressing burnout by fostering a sense of community at work, 2 strong social relationships, 2,11,12 a collegial environment, 2 manageable workloads, 9,11,12 employee involvement in decision-making, 11,13 a sense of agency and job control, 2,11,13 and a culture of caring and compassion. 9 As Jennifer explains, ensuring fair and equitable treatment is also critical (eg, addressing gender gaps in pay by increasing pay transparency and facilitating equitable promotions). 9 Alexandria Blacker and Shimi Kang provide additional insights into important steps employers can take to prevent burnout.
Gallup’s work has highlighted that managers are a linchpin in the employee experience: They can prevent burnout by listening, setting clear expectations, removing barriers, facilitating collaboration, helping employees connect their work to the organization’s mission, and ensuring employees feel fully supported in using their strengths. 15 Managers can also send an important message by encouraging their team members to disengage when they aren’t working. Avoiding late-night e-mails, disconnecting on evenings and weekends, and taking time to recharge during the day model healthy recovery opportunities. 12
The dialogue about workplace influences on burnout wouldn’t be complete without a consideration of the role of enhancing control via workplace design to modify the physical environment. Often, these conversations center on sound. There appears to be a growing consensus about the importance of limiting acoustic disruption with sound masking or sound absorption and ensuring access to designated quiet spaces. 8,13,16 Lighting is another important factor. 13
This issue was conceived and written prior to the emergence of COVID-19, which is already having an untold impact on burnout among many professionals, including health-care workers and first responders. For these brave individuals, the mental and physical exhaustion of long hours is or likely will be compounded by ethical dilemmas regarding seemingly impossible triage decisions, the grief associated with losing patients and colleagues, concern over insufficient personal protective equipment, uncertainty, fear about being infected or transmitting infection to loved ones, and the logistical challenges of child care in the face of school closures. 17 Prior research indicates that health-care workers who treated patients during the SARS outbreak had higher levels of burnout, distress, and post-traumatic stress disorder 1 to 2 years later than colleagues who did not treat affected patients. Perceived adequacy of training and support had a protective effect. 18 There has never been a more critical moment to heed Amaryllis’ guidance about humanizing the workplace to provide the resources, logistical assistance, psychological support, and opportunities for recovery health-care professionals will so desperately need. Leading industry journals have already made recommendations regarding frequent, transparent, and thoughtful communications; supportive conversations; clear guidance when recommendations exist; efforts to minimize misinformation; decompression time; rest breaks; and efforts to reduce anxiety. 19 Front-line workers also deserve our respect, recognition, and sincere gratitude.