Revisiting burnout in a Covid-19 landscape

A roadmap to employee wellbeing

Background/History

Burnout was originally attributed to the field of social work, the thinking was that employees of the social work sector may develop burnout due to the highly emotional demands of client-work (Maslach and Jackson, 1981). The definition of burnout was later broadened, so that any kind of work is now potentially considered to bear a risk of burning out (Schaufeli and Taris, 2005), with an estimated prevalence of 13% to 26% (Norlund et al., 2010 and Adriaenssens et al., 2015).

In 1997, Maslach & Leiter rephrased burnout as an erosion of engagement with the job.


Defining burnout

Burnout encompasses emotional exhaustion (a depletion of emotional resources and feelings of being overextended by work), cynical attitudes toward work (a mental distancing from work), and reduced personal efficacy (negative evaluation of one’s own work, leading to feelings of insufficiency and poor work-related self-esteem) (Maslach et al., 2001).


The cost of burnout

The diagnosis of “burnout” is based on self-reports and how individuals communicate their symptoms. Burnout is not regarded as a “classical” stress disorder, but it is often preceded by periods of acute or prolonged stress (Henry, 1992; McEwen, 1998 *) and is considered to be associated with adverse health effects via constant stimulation of stress systems in the body (Danhof-Pont, et al., 2011).

Burnout is considered a major risk factor for health issues such as cardiovascular diseases (Toker et al., 2012; Leiter et al., 2013). There is also some suggestion of overlap with depression (Bianchi et al., 2015).

The classification systems DSM-V (Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 2013) and ICD-10 (International Classification of Disease; World Health Organization, 1992) do not include burnout as an independent clinical diagnosis. In the ICD-10, burnout is mentioned within the residual category Z 73 — problems related to life management difficulty.

The Swedish and the Dutch health systems provide standardized diagnoses that integrate burnout as a definable syndrome (Van Der Klink and Van Dijk, 2003; Schaufeli et al., 2009).

The modern organisation must respond rapidly to changing environments. At the same time, the work we do is becoming more complex. This is one explanation for the increased incidence of burnout. Burnout has become a major concern to organisations, primarily due to the cost in terms of lower job performance, higher turnover, lower organisational commitment, lower job satisfaction, higher health care costs, and reductions in creativity and innovation (Halbesleben & Buckley, 2004; Shirom, 2003).


Causes of burnout

  1. Powerlessness: It has been suggested that there is a link between social determinants of health and burnout with burnout more likely to occur in a clinical setting when the realisation hits that the patient seeking help is experiencing socioeconomic that are actively causing harm in ways no medicines can touch. When individual powerlessness is the crux of this source of burnout, collective advocacy to address the harmful social determinants of health can buoy physicians’ morale and be an act of self-care. (Eisenstein, 2018).
  2. High expectations and altruism: Following a series of fatal mid-air collisions linked to human error, the Federal Aviation Administration commissioned a prospective cohort study in 1973 from Boston University School of Medicine (FAA/AM-78/39: Part 1 and Part 2). This study is one of the first investigations into workplace burnout and followed 416 air traffic controllers over three years. It resulted in a report of over 650 pages. The report identified burnout, increased incidence of hypertension, and signs that controllers developed other psychiatric problems over the course of the study. The report concluded that those who feared burnout were actually the more competent individuals, and that burnout concerns, once set in motion, tended to become a self-fulfilling prophecy.
  3. Changes to the psychological contract between employee and employer. The belief in what the employer is obliged to provide based on perceived promises of reciprocal exchange (Rousseau, 1995). Employees are expected to give more in terms of time, effort, skills, and flexibility while receiving less in terms of career opportunities, lifetime employment, job security, and so on.
  4. Job-person fitA better fit predicts better adjustment and less stress (French et al., 1974). Mismatches can occur when the process of establishing a psychological contract leaves critical issues unresolved, or when the working relationship changes to something that a worker finds unacceptable.
  5. A lack of social supportLack of support from supervisors and co-workers. This support acts as a buffer between job stressors and burnout.
  6. Workload and time pressureExperienced workload and time pressure are strongly and consistently related to burnout, particularly the exhaustion aspect of it.
  7. Role conflictWhen conflicting demands at the job have to be met.
  8. Role ambiguityA lack of adequate information in order to do the job well.

Burnout prevention strategies

According to Maslach, et al (2001), burnout arises from chronic mismatches between people and their work setting in terms of some, or all, of the following six areas.

Workload, control, reward, community, fairness, and values.

WorkloadIs there too much work, or just the wrong kind of work?

People may be able to tolerate the workload if they value the work they are doing and feel that is important. Stressful demands can have the potential to offer challenges by promoting mastery, personal growth, or future gains. Examples of challenges include demands such as a high workload, time pressure, and high levels of job responsibility. Employees tend to perceive these demands as opportunities to learn, achieve, and demonstrate the type of competence that tends to get rewarded.

Control. Are you expected to produce results without the capacity/resources to deliver them?

Britt’s (1999) triangle model of responsibility positions job clarity, job control, and job relevance as keys to engagement. Stressful demands have the potential to thwart personal growth, learning, and goal attainment. Examples of stressful demands include demands such as role conflict, role ambiguity, organizational politics, red tape, and hassles. Avoid an emphasis on the development of personal resilience as part of professional excellence. The study on air traffic controllers found that burnout was not simply a failure of personal resilience: most air traffic controllers had experienced military service and had dealt with extremely challenging conditions.

Reward. These can be financial or social e.g. appreciation.

Explore the underlying motivation behind striving hard to meet internal and external professional ideals. People who have high expectations of themselves can be driven to work too hard and do too much leading to exhaustion and eventual cynicism when the high effort does not yield the expected results. A major motivation for individuals with pathological altruism is to please others, gain approval, and avoid criticism and rejection Bachner-Melman and Oakley (2016). “What we value so much, the altruistic ‘good’ side of human nature, can also have a dark side. Altruism can be the back door to hell.” Oakley et al. (2012).

Community. Some jobs isolate people from each other or make social contact impersonal.

Harter et al., (2002) suggested 12 diverse work characteristics and management practices that function as key causes of engagement, some examples of which include clarity of work expectations, supportiveness of supervisors and coworkers, and opportunities for growth and development.

Fairness. Fairness communicates respect and confirms people’s self-worth.

Is the working environment truly healthy? Build engagement by giving employees an opportunity to address fairness and equity. Surgical residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than surgical residents with no reported mistreatment exposures to have symptoms of burnout.

Values. People might feel constrained by the job to do things that are unethical and not in accord with their own values.

There may be a mismatch between their personal aspirations and the values of the organisation.

Job characteristics that promote the experience of meaningfulness and responsibility are highly associated with internal work motivation (Fried & Ferris, 1987; Hackman & Oldham, 1980). As people feel that coping efforts will be effective and expect to experience meaning in meeting these challenges, they become more willing to invest the energy to adopt more active, problem-focused styles of coping, and such investments should be reflected in greater engagement.


The Covid-19 landscape

It is not difficult to understand how social isolation resulting in a lack of community under Covid-19 will have negatively impacted employee engagement and as a result, increased employee vulnerability to burnout.

There is also a values aspect to the Covid-19 era with the heightened potential of employees questioning what the nature of their work may mean in the context of a pandemic. If the job-person fit is no longer right, it could cause burnout and the person to seek to change career altogether.

Equality, diversity, and inclusion have never been more relevant than in 2021 with an increase in working from home and employees now realising that old ways of working and presenteeism no longer fit their needs. While some employees may have reported a decline in mental health due to a lack of interaction with colleagues and an increase in exhaustion due to more screen time, others may have been reporting an improvement in existing health conditions and the value that having more flexibility to their working pattern offers them.

The reward that may make the workload more achievable, and provide the capacity/resources needed to deliver it, could be to allow people to choose how they do their work, and where, giving them control over their own environment. But, are 2021 employers ready to allow that to happen?


Other References

*Henry, J. P. (1992). Biological basis of the stress response. Integrative Physiological and Behavioral Science, 27, 66–83 doi: 10.1007/BF02691093

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