The term “burnout” first came into use in the early 1970s in the context of air traffic control, after an increase in human error-precipitated collisions was linked to frustrations with increased traffic, poor human-machine interfaces, and the general monotony of the work. Described by the WHO as “resulting from chronic workplace stress that has not been successfully managed,” burnout is characterized by “feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.” But just as the early research on burnout showed it to be a fundamentally systemic problem—since the air traffic controllers being studied were extremely well-trained in coping with stress (many were military veterans)—more recent researchers also describe the causes of burnout as collective, and impossible for an individual to fix without a systems perspective.
Factors like overwork or insufficient resources play a role in burnout, but according to Christina Maslach, of University of California, Berkeley, and Michael Leiter, at Saint Mary’s University, it’s at least as important to focus on fairness, transparency, and purpose in the workplace. Comparing workers to cucumbers in vinegar, Maslach said: “We should be trying to identify and analyze the critical components of ‘bad’ situations in which many good people function. Imagine investigating the personality of cucumbers to discover why they had turned into sour pickles without analyzing the vinegar barrels in which they had been submerged.”
Burnout is undeniably costly. While individuals with full-blown cases can lose months and years of wages and carry the burden of expensive mental health interventions, more than half of all professionals fall somewhere on the burnout continuum. Burnout increases risk of coronary disease and type II diabetes, is associated with lower heart rate variability—generally understood to be indicative of reduced worse health and aging—and there have been studies of telomeres (protective caps at the end of chromosomes) that indicate telomere shortening usually associated with biological aging. Burnout has neurological implications, associated with thinning in the prefrontal cortex, larger amygdala, and smaller caudate, giving people less capacity for decision-making and implicating memory, attention, and emotion regulation. And beyond the physical implications of burnout, there are significant economic and social costs: Beyond the cost of treating burnout, research indicates severe consequences for burnout on relationships, especially our closest relationships. A partner of someone who burns out is at higher risk for burnout themselves, especially given compassion fatigue. Burnout costs organizations $120-190 billion a year, a rate comparable to cancer, at $172.8 billion in losses a year.
How can we stop blaming cucumbers for becoming pickles? How to mitigate the acidity in the environment? Individuals can’t yoga or meditate their way out of burnout. Indeed, heightening pressure on already-stressed individuals to “fix themselves” only perpetuates the cycles of stress. Organization-level interventions are needed.
The Causes of Burnout
If we can better understand what causes burnout, we can detect it before it unfolds into complete mental and physical collapse. This means learning how to recognize an early phase symptom like “workaholism” for what it is, before it blossoms into a crisis.
Causes of burnout can appear at all three levels of an organization:
- Personal predispositions and character, such as perfectionism, and positive affect
- Personal situations, such as the stress we experience, the support networks we have created for ourselves, or the type of job we are in
- Personal coping and regulation mechanisms, such as how well we are able to self-regulate our emotions and process them
- Underlying team structures, such as the size of the team, how they collaborate, and how they get things done
- Atmosphere created within the team, such as the degree to which people communicate openly and are able to take risks
- Level of transparency in the organization, such as how readily leadership shares salient information with employees
- Organizational structures, such as vacation time and other benefits and role clarity
Wellness Is Not the Answer
Wellness in the workplace is an $8 billion industry in the United States, and forward-thinking workplaces may think they are doing a great service by offering yoga, meditation classes, and other wellness services. But the research reveals that those efforts are not working. A 2019 Harvard Medical School study published in the Journal of the American Medical Association (JAMA) shows that workplace wellness programs had no impact on overall health, sleep quality, nutrition choices, health markers, or health care usage, failing to move the needle on the very issues that they claimed to redress. The programs also failed to improve basic workplace metrics such as absenteeism, performance quality, and retention of key employees.
The current spend on wellness is not fixing the problems it targets. So what can? First, we must broaden our definition of the term and better understand that burnout is not a yes or no (you have it or you don’t) condition.
Burnout Is a Spectrum That Can Be Measured
With a broader view of what burnout is—less like an off/on switch and more like temperature-taking—we can begin to measure burnout. As the saying goes: “If you can’t measure it, you can’t improve it.”
New definitions of burnout have allowed us to recognize that:
- Burnout is not binary. Most believe that one has the condition or does not have it. Yet it is actually a spectrum and one that starts with seemingly harmless symptoms.
- Burnout is distinct from depression and anxiety. Although it has some overlapping symptoms, it definitely manifests differently and is often caused by a broader set of environmental factors.
- Burnout should not be conflated with compassion fatigue. Compassion fatigue is a specific subset of burnout—associated with medical professionals, teachers, and social workers—which relates to the diminishment of empathic response over time. But it’s a misnomer in the sense that compassion does not become depleted whereas empathy does. Compassion activates the reward response in the brain, but empathy fires the pain response, mirroring the pain of the person being supported. Burnout is primarily a response to job demands, fairness, transparency, and other issues beyond responding to pain over time.
There are various measures of burnout: the MBI (Maslach Burnout Inventory), the CBI (Copenhagen Burnout Inventory), and Freudenberger’s 12 stages of Burnout. But current measurement tools here are limited in three main ways:
- They often confuse symptoms of burnout with risk factors of burnout, which is like equating someone having genetic predispositions to a condition with having it.
- They are designed to be measured at an individual level only, despite the fact that most causes of burnout are either outside an individual’s control or informed by their environment.
- They do not segue easily into action-taking, which is particularly problematic for a condition whose definition includes a lack of personal efficacy. Providing results without providing immediate assistance in action-taking is at best careless, and at worst irresponsible.
Early intervention offers the possibility to mitigate damage. While it takes an average of 14 months to two years to recover from full-blown burnout, catching burnout upstream in an earlier phase can reduce cost and length of interventions. To do this requires organizational awareness from leadership and managers, and requires regular collection of data at the individual, team, and aggregate levels of burnout.
I argue for the imperative to create action-oriented, team-based diagnostics, since it is easy to miss burnout at the individual level. It’s hard, if not impossible, to self-assess because early stages of burnout masquerade as workaholism and believing you aren’t at risk is a risk factor. The causes of burnout are social, and its measurement should reflect that. It is critical to understand how clusters of people are faring with burnout in order to lead to interventions that work. Individual-level action-taking is hard because it’s hard to stay accountable and often stigmatizing. But change can be harnessed at the team level. By going to the team-level, you spread the responsibility out and make it easier to stay accountable. Team action-taking is also more nimble and can happen more quickly versus trying to change an entire organizational culture at once, which can be quite complicated.
A better diagnostic approach would ask questions at all three levels—individual, team, and organization—to understand both the cucumber and the vinegar it finds itself in:
“Do you see the world as a place full of opportunity?”
“Do you feel a sense of autonomy and voice in your team?”
“Do you feel that reward systems in your organization are fair and transparent?”
In case studies we’ve done with medium and large organizations, diagnostic tools have helped organizations determine where they are on a burnout spectrum and take effective actions: what gets measured can be improved.
With Entrepreneurs Organization we worked with a team of 150 people that completed full burnout and resilience diagnostics, which included 33 risk factors that contribute to burnout risk. We were able to extract the three major themes for the organization to focus on, and to sequence action-taking based on their scores and organizational needs. This burnout work will be embedded in their strategic planning at the highest levels for cultural change, benefit change decisions, and training budget decisions. In addition, each of their 11 teams received customized action-planning support based on their results which included: team coaching with highly qualified and trained coaches, and nudges that are customized to each team’s chosen course of action.
At Space Center Houston, we worked with a team of 50 who completed diagnostics to assess their burnout risk factors. In 2020, Houston has been specifically hit hard by both the COVID-19 pandemic and natural disaster damage caused by Hurricane Laura, so organizations in the area have been incredibly sensitive to burnout within their teams. The data from our diagnostic outlined patterns of risk factors that recurred across individual, team, and organizational level. The results of those will allow for more thoughtful decision-making around benefit, training and culture change decisions for the organization today and in the future.
There are also lighter lift entry points for getting started. For example, Stanford Hospital staff members were given a two-minute quiz (link here) to better understand their resilience typologies as a group, helping them understand what might make them more or less at risk of burnout as an individual and as a team. They also got a snapshot of their motivational styles and coping strategies that set them up for conversations on how they could support one another more effectively.
How to Create a Burnout Shield
While it may be frustrating to know that more meditation won’t necessarily save individuals from burnout, there are organization-level strategies that companies can take up to safeguard their greatest resources, their people. Programs that are directed at individuals can have an impact, but only for about six months or so. But when the intervention targets the organization (e.g. task restructuring, evaluation changes, supervision shifts impacting job demand, and ability to influence decision-making) the impact lasted up to a year. When the personal and organizational are combined the impact is longer and stronger. But it is critical to realize that burnout work can’t be done as a one-off; it needs to be a constant effort over time.
Examining Managerial Behavior. Research shows that bad relationships with direct managers account for 75 percent of turnover. Too often, managers are incentivized to focus on short-term productivity metrics and are not trained to understand what is needed for sustainable individual and team performance. Extensive research by the military on sustainable performance in stressful conditions teaches that leaders should become champions of health, rather than taskmasters that drive teams and organizations to burnout.
Upholding Fairness and Transparency. There are some interesting pieces of research on the fact that even monkeys value fairness. We are wired this way. As a result, when promotions are distributed unfairly, it contributes to burnout. This is especially true for groups that experience bias and microaggressions daily, who see themselves, and people who look like them, sidelined from advancement in the organization. People need coherence, purpose, and fairness to be healthy. Managers must understand that the behavior they model and the way they distribute work steers their team toward health or dysfunction and determines the ensuing human and organizational cost.
The Role of Health Intrapreneurs. Health intrapreneurs are essentially educated champions (often self-designated) who take a leading role in building sustainable workplaces, a strategic component of their role and their company’s edge. Health intrapreneurs understand the interplay between the workplace and its impact on employee health and vice versa. From an organizational perspective, health intrapreneurs support engagement and retention, both key bottom line metrics across sectors. The steps toward becoming a powerful team health intrapreneur in an organization often include intrinsic interest in the subject, early adoption of best practices, and experimentation with ways to enlist employees in the vision of creating energizing workplaces. Intrapreneurs, or health champions, are leaders (often self-designated) who spark social innovation within their companies. They can affect change in an incredibly powerful way because they are close to the problem and can recruit agents of change such as managers and team leads into their efforts.
Focusing on the Four Pillars of Team Resilience. The four pillars are designed to instruct organizations on how they can begin to make lasting change at the cultural and organizational level, rather than putting the burden on individuals alone. These four keystone components are critical to moving toward a culture that’s more protected from burnout and its resulting churn. The four pillars of Team Resilience are:
- Self-Awareness. Teaching individuals to know their triggers, needs, and their sense of purpose. Ensuring that within teams there is enough vulnerability for people to share what they see as their purpose, strengths, and values is essential.
- Autonomy. Team members must have an appropriate balance of autonomy and support in the work they do.
- Structured R&R. The team needs guard-rails on intensity and quantity of work. Managers need to ensure workloads are evenly distributed, and that time for rest is protected and even encouraged.
- Community. For burnout to be truly guarded against, team members need to feel a sense of community, collaboration, loyalty, tolerance, and psychological safety.
Where We Go From Here
The ubiquity of toxic organizations can and must end. We are in the right moment of history to make major changes to what we expect from organizations, even as COVID-19 is redefining the barriers of the home and work. We have massive, irrefutable data that catalogues the downside of ignoring workplace health, including the organizational costs and the ensuing human misery.
Too often, the onus for well-being is placed onto the individual for issues that are, by their nature, systems-level issues and often occurring at the team level as well. Until we reframe the conversation, we can’t make critical changes to workplace culture and team structure, and the very real human pain and economic damage that burnout leaves in its wake will continue to proliferate. We need a wellness 2.0 approach that takes into account the implications for individuals, teams, and systems. It is time for a complete overhaul of how we understand workplace health based on research and data. From this starting point, changes that move the needle can be implemented for the individual, the team, and the organization.