Burnout and Workplace Culture

I read this[1] fascinating and experience-affirming article a few days ago about burnout. I wrote an article a few months ago about the ways that providing compassionate care can protect against burnout in healing professions, but there were still some gaps in my understanding of this complex topic. I understood the individual side of things - when individuals can provide compassionate care, individuals have less burnout. Of course it's more complex than that. The common prescription for burnout that we see in today’s culture typically involves self care. Be sure to spend your free time taking extra great care of yourself, because this job is really only getting worse.

However. Let me quote the article’s main point, “…three decades of research has demonstrated that work environments, not individual workers, have the greatest impact on the possibility of burnout and worker turnover.” While I wasn't wrong in my understanding that individuals can impact their own levels of burnout, I was clearly missing this HUGE environmental piece. There are 3 main dimensions of burnout, including

-Exhaustion dimension (depletion, fatigue, etc.)

-Cynicism dimension (loss of positive regard for patients, loss of idealism, etc)

-Inefficiency dimension (low morale, decreased productivity, etc)[2].

Research shows that the most common environmental contributors of burnout include

-Excessive workloads,

-Lack of flexibility,

-Lack of autonomy,

-Workers feeling they are not meaningful change agents,

-Self-sacrifice promoted as the model of work,

-Getting shut out of opportunities,

-Loss of shared common meaning/purpose at work

-Inefficiencies in the workplace[3].

This list sounds like so many health care providers’ experiences and has been my experience at different times of my career. Today, I would like to highlight two experiences that COULD have provided some buffer against burnout, but actually resulted in the opposite feelings.

My first example highlights the environmental contributors of self-sacrifice promoted as the model of work, lack of autonomy, and loss of shared common meaning/purpose at work. Someone I know is a physician who completed his fellowship training at a major national medical center. Always on the cutting edge, this hospital implemented a peer-to-peer support system for physicians to counsel and encourage each other through difficult or traumatic outcomes at work. Physicians who volunteered to be the on call supporters would be able to take as many or as few calls each week as their schedules allowed, and they went through an extensive training process. My friend volunteered to be one of these support physicians, and he was very excited about the idea of the whole project. There is something singular about the types of decisions that physicians have to make, as well as about the traumas that they face in normal work days. In his experience, the only people who can truly empathize are others who have been through the same situations. It felt like a compassionate solution to protect morale, facilitate connection, demonstrate shared purpose, and social support.

Fast forward to 6 months in the program. During my friend’s scheduled week off, he was asked to provide social support to several other physicians. He agreed to call and speak with one, but told the coordinator that he would be unable to take more than one. He felt very generous about volunteering during time off, and did so out of a shared sense of connection and affection for his peers. The coordinator proceeded to tell him off and verbally shame him about not accepting calls from ALL the physicians needing support. She told him he was selfish, uncaring, and basically wrong for wanting to spend his time off as previously planned…not working. Being brutally reprimanded for setting an appropriate boundary, and even trying to be generous within that boundary, rather than accepting the culture of over-work and bending to the expectations of the facility is exactly the kind of thing that leads to burnout…which is what the peer-to-peer support program was supposedly trying to combat.

In the second example, I would like to illustrate the way in which words and presentation of information can support or destroy morale. This same physician works in a different hospital now, but, as in every hospital right now, burnout is high after 2 years of covid. In honor of National Doctor’s Day, this hospital sent out a celebratory email thanking doctors for their hard work and honoring all hospital employees with a bonus. Which IS a kind gesture, except that physicians are not hospital employees – they are all subcontracted out. Additionally, all the janitorial and environmental services staff are subcontracted. So, doctors were not part of the system wide plan to honor doctors, and employees who needed the bonus the most were notified about it but did not receive it. Rather than boosting morale and shared common meaning/purpose, the bonus alienated physicians and environmental services staff.

This “National Doctor’s Day bonus” really amounted to a gift for nurses, which is not inherently a bad thing! Nurses deserve to be praised, thanked, and supported for their daily efforts to care for patients, especially 2 years into covid. However, words matter. Nursing week is coming up, and this would have been a wonderful gesture to celebrate nurses and build morale during their designated week. Instead, those who work at the hospital but are not employees of the hospital, like doctors and custodial staff, were made to feel unseen during what should have been a camaraderie building gesture. It left my friend wondering whether the hospital decision makers actually knew which employees were contracted out to different companies. He wondered whether the intent was to leave doctors out of their own celebration day, or whether it was accidental – and which scenario would even be more or less excusable.

Both of these examples illustrate that, while the leaders of work environments might set out to enact compassionate policies to buffer against employee burnout, a misguided attempt can actually be more harmful than helpful. It would be a transformational shift to provide or even require compassion training for administrators and team managers, so that these people could create environments where people feel valued, that their efforts are worthwhile, and that they make a difference – thus protecting against burnout. And, in this moment where burnout is so rampant, it might be a timely adjustment to healthcare management if employee retention is a priority. We cannot ask employees to "self care" their way out of burnout, and workplaces should accept their responsibilities for combatting burnout with culture.

[1] https://thebeautifultruth.org/life/mental-health/self-care-is-not-the-solution-for-burnout/?fbclid=IwAR3eYAtAAA03iCAGWAV5KXV-bbecSFrLvnDkoJ_3Ku0aGvyn2EMHrP5MBoM [2] https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20311 [3] List by Dr. Maslach, as listed in a presentation on burnout, cited by Dr. Justin Henderson