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An Occupational Medic's Guide to Understanding Burnout

Written by Farhan Shahzad, Occupational Physician, and Sarah Davies-Robertson, writer and psychotherapist





Burnout: A Brief Overview


Occupational burnout is a psychological syndrome that causes emotional exhaustion, depersonalisation or cynicism and a lack of accomplishment or inefficacy, which is the result of prolonged stress.


There are five further costs: physical, emotional, interpersonal, attitudinal and behavioural. Occupational burnout is both an organisational and employee issue. It is linked to lower job satisfaction, higher attrition rates, morale problems and staff turnover. The impacts of burnout cost organisations through loss of employees, rising sickness absence, and even presenteeist behaviour. Burnout compromises an employee’s performance, leading to lowered productivity and further organisational costs.


In employees, burnout causes both mental and physical health problems. The causes of which has been linked to office politics, menial tasks that interfere with actual work (Cook, 2006) and job characteristics such as role ambiguity, conflict, work overload (Cook, 2006) and lack of autonomy. Problems with managers are also an issue, as are the lack of reciprocation in the psychological contract.

Research has shown a burnout cycle, whereby employees display certain burnout tendencies and behaviours. They begin with feeling exhausted so engage in presenteeist behaviour, which later leads to exasperated levels of exhaustion. Employees begin to work hard to mediate against the effects of burnout, but in doing so they cause greater exhaustion. Other perspectives centre on employees working hard and long hours, displaying presenteeist behaviours, which leads to further exhaustion, followed by more presenteeism. It’s a chicken and egg phenomenon.


Researchers are on the fence as to what causes it- whether it is situational, individual or both. However, while individual differences, such as personality type and behavioural traits do play a role, and that burnout is mostly caused by situational factors, especially situational factors that do not breed the desired result. In fact, the better the worker, the more prone to burnout. Job demands, such as that discussed in the Job Demands Model, are linked to occupational stress and therefore burnout, which can be mediated by support from family and friends.


While burnout was originally researched in the helping or people professions, it is not limited to these professions. Burnout is on the rise in occupations within the so-called square mile, where individuals are becoming deflated by the long hours, lack of organisational commitment and no real sense of purpose. Its impact transcends the organisational impact, and not only impacts on health and wellbeing, but the negative attitudes and loss of feeling caused by exhaustion, coupled with loss of idealism and purpose means that family and social life are affected. Burnout leads to withdrawal of normal behaviours and pleasures, which further impacts on the wellbeing of the employee.


For those in the service-related industry, such as teaching, health and social care, it is particularly problematic because it impacts on the wellbeing of patients under the employee’s care. It can lead to decreased performance that impact on patient care. Likewise, the impact of suffering in patients can affect employees, leading to burnout. Those in mental healthcare are particularly prone, due to the embodying nature of their role and use of empathy, with those in longer service exhibiting high rates of burnout. Social workers and psychiatrists are particularly effected, rather than their colleagues, psychologists and support workers, who exhibit less signs overall, which risk a loss of compassion and empathy towards their clients.


Outside of healthcare, those working in people facing roles, such as teaching and lecturing, are also at risk. Journalists working on sensationalised news pieces that deal with violent and traumatic events are also at risk.


The Health and Safety Executive (HSE) have issued a report into stress reduction in the workplace and offered advice for organisations to help reduce stress. This is known as their Management Standards and includes six areas: demand, control, support, relationships, role and change. Their advice is for workplaces to manage these characteristics properly to mediate the effects of organisational stress that can lead to burnout. Healthy working environments, work-life balance and social support are proven mediators against organisational stress.


Mediating Factors


According to the Conservation of Resources Theory (COR), there is a link between work-family balance and the three components exhibited during burnout. Employees have limited resources, and if their family time is compromised, this impacts on their work.


There are three components to the Conservation of Resources theory, which states stress can develop under three of the conditions: 1) loss of resources such as income; 2) threat or perceived threat of loss of resources and 3) what is expected does not take place (psychological contract is broken). Organisations can be clear on their expectations, making sure to avoid ambiguity when dealing with employees, and offer family friendly policies, which have shown to help prevent burnout.


Further to the research on mediating factors, organisations must effectively manage individual differences. Different personalities respond in differing ways to stress. Those on the introverted side of the intro-extra scale can suffer from collaborative overload and need time to recharge in isolation, meaning that organisations should also manage burnout by being employee focused and engaging the employee in the process.


The High Octane Woman


Sherrie Bourg Carter coined the phrase ''high octane woman' in her book, High-Octane Women: How Superachievers Can Avoid Burnout. The book discusses an important facet of stress management, one where a one-size fits all approach is not helpful in combatting burnout.


We are all individuals with a unique personality and a unique set of circumstances. We cannot rely on one approach to treat something as complex as mental health. Teaching resilience and stress management is a multifaceted approach that relies on supporting a person wholistically.


If you are in an orgnisation where stress management is overlooked in favour of results, and where mental ill health is trivialised, then it may be time to find another job. Organisations like this can damage a person's health because they place the bottom line above health and wellness.


On the flip side, outside factors do play a role in a person's ability to manage stress. There could be a 'tip of the iceberg' phenomenon which is the straw that broke the camel's back and tips someone over the edge. The cumulative effect of stress should not be overlooked.


Finally, a person's temperament is important in seeing how they handle stress. Those with more relaxed personalities that have an internal locus of control are more likely to overcome stress than those that score highly on the trait neuroticism.


Dr. Farhan Shahzad is medico legal doctor based in Sydney, Australia. You can visit his website here: drfarhanshahzad.com

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