"Burnout" at work

A failure of imagination and empathy

How would you make sense of the following vignette: 

• Over a 50 year period, a disease (“X”) is diagnosed, its etiology is defined, and effective treatments are prescribed

• Thousands of journal articles and books are written about X

• Thousands of people make a living offering advice and treatments for X

• 30-50+% of people working in organizations are currently suffering from X and cry out for relief

• All the stakeholders in the afflicted organizations not only fail to apply best practices for preventing/curing X; they actually enable its drivers/vectors to intensify

As incredible as that all sounds, it is in fact the natural history of the occupational health syndrome referred to as “burnout”. In 1974, Herbert Freudenberger wrote about a condition he observed among the staff in health clinics which he described as a state of mental and physical exhaustion caused by one's professional life. He labeled this condition burnout and defined its symptoms, phases, causes and cures. In 1981, Christina Maslach created the first diagnostic tool for burnout that has been used in thousands of studies of the disorder’s causes and treatments.

In 1990, Karasek & Theorell reviewed the extensive research on the so-called demand-control model of burnout (which they call “work strain”). This research (which has only expanded over the past nearly 30+ years) demonstrates conclusively that when people (a) are required to manage a workload that exceeds their adaptive capacity, and (b) do not have adequate decision-making control over how, when and where to do their work, they are at increased risk of developing serious health conditions such as anxiety/depression, substance abuse, cardiovascular disease and worse. Given that etiological pathway, delegating more decision-making authority/control to the people who do the work is clearly the best way to decrease and even prevent work strain/burnout.

Given this massive program of research into the etiology and management of workplace burnout over the past 50 years, you would think the problem had been solved by now.  And yet, prevalence rates of burnout symptoms among physicians/nurses, teachers and other workers in the USA have lately soared to 30-50+%.  How can we understand this disconnect between what we “know” and what we are doing (or NOT doing!). The answer has to do with how people often fail to learn from experience, especially “failure”.

Don’t believe everything you think

It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so. — (anonymous, though attributed to Mark Twain)

I have noticed that many smart people fail to solve their most important problems by holding on tight to certain cherished ideas and beliefs and assumptions and theories. They have so much “faith” in their mental creations that they never question or replace them, even when they are in fact the root cause of continuous failure.

Despite the evidence that workplace burnout is largely caused by environmental/systemic factors (see the demand-control model of work strain above), many leaders and human resource professionals remain enthralled with a “medical model” of burnout. The core beliefs of this paradigm include:

• If a person is suffering from a health condition/symptom, it is because of a disease process INSIDE of that person

• The first step in curing a patient is to diagnose the illness IN them

• The last step is to treat the illness IN them

If leaders view burnout as a set of symptoms “inside” of people, that will drive them to prescribe person/symptom-focused interventions such as stress management (now called mindfulness/resilience) programs and anti-depressants (and negative performance reviews!) despite their demonstrable ineffectiveness over decades.

If we don’t view burnout as a problem inside of people and then “treat” those individuals, what can we do instead? The best option is to shift the paradigm from a closed-system medical model to an open-system public health model that looks for multiple interacting causal vectors of dis-ease. Once these vectors are defined (e.g. mosquitoes as the primary vector for transmission of the parasite that causes malaria), they become the focus for both intervention and prevention efforts .

A systems model for burnout

In my work with professionals and organizations dealing with burnout, I have discovered five domains with which my clients are deeply engaged every day at work:

1. Cultural (What is real? What is good? How do things work here?)

2. Economic (Who deserves to get/keep the money?)

3. Technological (Whose interests do the machines serve?)

4. Organizational (Who has the power to make what decisions? What do we value most?)

5. Professional (What are the values, core beliefs and common practices of the people who work here?)

Powerful ideas and beliefs and assumptions are embedded within each of these domains, and the resulting actions are the proximal drivers of what I call Hyper-Work, a situation where work demands exceed the adaptive capacity of a person or organization. Entrenched belief/action patterns in each of these five sectors create a silent but powerful force field that drives people to work beyond their capacity and to remain largely silent about the suffering this Hyper-Work causes. To learn from the decades of failure to deal effectively with the burnout epidemic, and to liberate (“disenthrall”) themselves from the bonds of self-defeating ideas and beliefs and practices that promote Hyper-Work, organizations must examine closely what they are all really thinking and doing in each of the five domains above.

But of course the resource that is in the shortest supply in the modern organization is exactly this TIME TO THINK, to contemplate, analyze, discover, experiment and innovate. Most people will tell you that deep thinking is a luxury they cannot afford when dealing with the daily press of urgent items on their crushing task list. When people are hyper-working, their mental capacity to examine their own core beliefs and attitudes about themselves and their work is short-circuited.

But any attempts to directly challenge or change the pattern of Hyper-Work will generate powerful resistance, even from those suffering the most, unless those critical beliefs and attitudes are first excavated and disarmed. Effective leadership in dealing successfully with the burnout epidemic will require investment of precious resources (time, attention, energy) to launch such a thinking/learning experiment in the service of deep change in how work is done.

Without the mental engagement required to fully grasp the self-perpetuating nature of burnout/hyper-work, organizations will continue to talk about and suffer from its symptoms as they have for the past 50 years. Since the best predictor of future behavior is past behavior, all organizational stakeholders (leaders, workers, customers, investors) should be very worried about the danger of continuing and even intensifying patterns of Hyper-Work resulting in a systemic talent implosion. It is not a purely dystopian fantasy to imagine a world in which we want a product or service and there is no one there to provide it.

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Here is an essay about the dangers of mental exhaustion and the type of culture that pushes people beyond their limits.

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Here is a presentation I made to a healthcare organization whose professional staff was fried to a crisp:

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