The rise of burnout and the critical role employers play in prevention
For several years, employers have had a legislative duty of care to protect the health and safety of workers that extends to incorporate mental health. Despite this ‘protection’, statistics indicate an increasing trend in the prevalence of mental health conditions including burnout, a disorder triggered by prolonged workplace stressors(1). Burnout not only has a detrimental effect on one’s overall wellness but also significantly impacts organisations’ through costly and often hidden issues including reduced productivity, presenteeism and increased absenteeism. In light of this, and accepting that the work domain falls largely outside of an individual’s control, Employers have a critical role to play in protecting employee wellness and in doing so will recognise the true value on their investment.
Over the past decade, the prevalence of mental/psychological disorders such as stress, anxiety, depression and burnout(1) has significantly increased as have the related claim costs which statistics show were amplified by 48% between 2000-2001 and 2012-2013(2). But indicators such as increasing financial costs take a compliance perspective and do not present a complete picture of the problem. Such figures fail to take the personal toll such disorders have on an individual’s overall wellness into account, or the flow on affect that compromised personal wellness has on organisations, making the true expense of mental conditions such as burnout substantially greater.
Burnout is defined as a ‘psychological syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment’(3) triggered by sustained workplace stressors(4). Burnout is often linked to various forms of personal dysfunction(3) such as insomnia and feelings of hopelessness that impact all aspects of one’s life. Despite experiencing such debilitating symptoms, individuals facing burnout may be in denial(5) or attempt to conceal its affects from others due to the perceived stigma associated with mental conditions and in fear of being labelled ‘weak’(6,7).
Given employee ‘burnout’ is not always apparent to others, it is reasonable to expect some ambiguity around the impact burnout has at an organisational level, a view supported by Cole(8) who argues ‘one of the biggest problems facing organisations is their inability to recognise the presence of burnout’. Research however demonstrates a positive correlation between employee burnout and organisational issues(1) such as presenteeism, an often hidden challenge where workers despite being physically present are not fully functional leading to reduced productivity(9), and employee absenteeism(8,10) all of which ‘cost companies billions of dollars a year’(9).
The significant financial consequences resulting from the effects of burnout are arguably sufficient to mount a strong business case for employers to act on prevention; however statistics indicate employers must do more. If employers are to move beyond compliance driven action towards accepting employee wellbeing and burnout prevention as a workplace responsibility, employers must first identify the reciprocal benefits between ‘well’ employees and positive organisational outcomes and appreciate the full value on investment (VOI).
VOI according to Grossmeier(11), whilst it may include return on investment (ROI) goes beyond to consider ‘the entire range of outcomes….of value to an employer’ which ‘for wellness may include elements such as worker productivity, employee satisfaction and morale, recruitment and retention, quality of life, and corporate brand or image(12). This can be achieved through employers developing a deeper understanding of wellness as a construct appreciating its multifaceted nature and innate connection with work.
Efforts to define modern wellness are evident as early as the 1950’s(13) with many offered definitions drawing on the ‘World Health Organisation’s (1967) definition of wellness not just being the absence of disease but a state of complete physical, mental and social wellbeing(14). Despite numerous attempts, examination of existing literature reveals no single definition of wellness exists, however wellness has been accepted as a multi-dimensional continuum(14,15,16,17). This is evident across a number of theories including Travis’ ‘Wellness Inventory’(18) citing 12 dimensions of wellness and the ‘Wheel of Wellness’ developed by Myers, Sweeney and Witmer(19) that proposes 16 characteristics of wellness.
Analysis of the dimensions identified in existing wellness models reveals that work/occupation/vocation is prominent across numerous models including both Travis and Myer et al’s models along with Hetler’s ‘Six Dimensions Model’(20) and Crose et al’s ‘Systems Model of Wellness’(16), thus signifying widespread recognition that work influences one’s wellness. Upon closer review of the occupational dimension throughout however, it becomes evident that ‘work’ is addressed purely from an individual’s perspective with dimensional descriptors focused around ‘one’s attitude about work’(14) as opposed to the influence a workplace has on one’s wellness. This emphasis on self-responsibility for one’s wellness typifies available wellness models evident in Travis and Hetler’s models and the work of Dunn(13) who accentuates mental wellness as ‘the responsibility of the individual’ that ‘cannot be delegated to someone else’.
Whilst personal responsibility for one’s wellness is vital, it can be argued that characteristics of the ‘work’ dimension such as ‘workload and time pressures (that) are strongly and consistently related to burnout’(1) fall outside of an individual’s control. This view is supported by Maslach(8) who states that burnout is ‘not a problem of the people themselves but of the social environment in which they work’. Given achieving high level wellness ‘requires that the individual maintain a continuum of balance and purposeful direction within the environment where he is functioning’(21) which includes the workplace, employees have no choice but to place some responsibility for the protection of their personal wellness, in this case through preventing burnout in the hands of employers.
It is evident from the literature reviewed that detecting burnout at the organisational level is challenging. In response to this, Maslach developed the Maslach Burnout Inventory (MBI) requiring respondents to self-assess against ‘the three components of burnout syndrome: emotional exhaustion, depersonalisation and reduced personal accomplishment’3. Whilst the MBI is a widely used tool(22,23), the stigma attached with burnout and other mental disorders may present some issues in accurately self- disclosing the effects of burnout which together with the lag indicators around the presence of burnout gives rise to concerns around the inventory’s validity.
In light of the difficulties detecting burnout, an argument mounts for prevention. In exploring solutions to prevent burnout it became evident that the majority of interventions to date have focused on the individual(24) which due to factors outside of an individual’s control that impact burnout, suggest limitations to their effectiveness. In light of this, Maslach et al(1) along with others(25,26) therefore argued that solutions must turn to organisational level interventions. As such Maslach, developed a recognised framework which considers the person within the work environment across six organisational domains: Workload; Control; Reward; Community; Fairness and Values said to contribute to burnout where a mismatch between the domain and person exists(1).
The costs of burnout are much more than financial. On an individual level, burnout has a significant impact taking a toll both physically and mentally often characterised by feelings of exhaustion and hopelessness(1). The personal nature of these symptoms and associated stigma with mental disorders however often results in burnout going unnoticed by others, but there can be little argument that burnout has a fundamental impact on one’s overall wellness.
The integrative and multi-dimensional nature of wellness makes it impossible to separate the impacts and influences of ones wellness between personal and work life making it inevitable that compromised personal wellness has a flow on affect to organisations. The difficulty at an organisational level however, is detecting the prevalence and effects of burnout beyond direct impacts such as workers compensation costs, given burnout is often correlated to indirect challenges such as presenteeism and reduced productivity which are both costly difficult to quantify.
Given the significant effects of burnout and the challenges in detecting it, it is argued that organisations have a better chance of preventing burnout(7). Prevention requires organisations to take action beyond that of meeting their existing legislative duty of care which statistics indicate are ineffective, to accepting responsibility for protecting one’s wellness. An incentive for employers to do so lies in recognising the full value of their investment in employee wellness which goes beyond financial returns to include unexpected benefits such as a positive workplace culture, ‘quality of life, and corporate brand or image’(12) all of which are mutually beneficial to both an individual and organisation.
Employers taking responsibility for employee wellness does not suggest that self-responsibility for wellness is exonerated, but instead proposes a dual responsibility in recognition that wellness is integrative in nature and there is a limit to an individual achieving higher level wellness given the work dimension is not within their complete control. Furthermore, interventions to address burnout have largely focused on individual level to date(1) however research shows individual interventions are less effective than those targeting organisational outcomes(27).
Maslach and Leiter(28) proposed a developmental model of job burnout which may provide a useful platform for organisations in preventing burnout. The model draws on the three components of burnout being ‘emotional exhaustion, depersonalisation and reduced personal accomplishment’(3) identifying six workplace areas that have the most impact on the three components of burnout. The model is ‘based on the degree of match, or mismatch, between the individual and conditions in the work environment. The greater the gap, or mismatch, between the individual and the job, the greater the likelihood of burnout’(10).
Burnout is a growing issue of which the costs and impacts are substantial to both individuals and organisations. On an individual level the physical and psychological effects of burnout inevitability affect one’s overall wellness which given the inextricably link to all aspects of life, has a negative and costly flow on affect to organisations often undetected. The challenges in detecting burnout at an organisational level have revealed prevention as the best solution. The incentive for employers to go beyond their legislative obligation to protect their employee’s health and safety lies in recognising the true value of return. As work, a demonstrated dimension of wellness falls outside an individuals’ control, a case for dual responsibility for protecting individual wellness has been mounted. Interventions must therefore move beyond targeting the individual to addressing burnout at an organisational level which is shown to be more effective in preventing burnout and Maslach’s framework offers a solid platform for organisations to begin.
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