Burnout is a psychological syndrome that results from chronic workplace stress that has not been successfully managed. One of the first issues is ‘stress’. Not everybody feels it in the same way. Not all stress is bad. People have difficulty being aware when they are under abnormal stress.

Then there is the problem of ‘unusual chronic stress’, which is long term high levels of stress that may be just under what may be considered ‘abnormal’. For example, if you’re ‘constantly on the go’ at work, with little time to think; you’re rushing through emails and responding quickly most of the time as your inbox flashes 200 more to go – that may be taken as the ‘usual’. But in reality it’s grinding you down over time. There are other situations – such as hurriedly preparing to do work e.g. meetings, skim reading reports without much thought, assessing clients, or assessing risk; or tons of forms to fill that you hurriedly enter some text just to say it’s filled because you know that nobody else has time to consider what you write with any depth of thought. Then you or someone else says, “Everybody is in the same situation, man-up!” (or something like that).

So, you button it and get on to prove you are in with the crowd. In the latter, you work an extra hour most days and even take home work. You’re proud to moan about it because ‘everybody’ else is doing the same. The ‘norm’ is therefore defined by what ‘everybody’ else is doing.

Historical background

The concept of burnout as a psychological syndrome was first developed by psychologist Herbert Freudenberger in the 1970s. Freudenberger was a practitioner who ran a free clinic for substance use treatment in New York City. He began to notice a pattern of physical and mental exhaustion, cynicism, and reduced efficacy among the clinic’s volunteers, which he recognized in himself as well. In 1974, he termed this phenomenon “burnout.”

Around the same time, another psychologist, Christina Maslach, was also conducting pioneering work on burnout. She developed the Maslach Burnout Inventory (MBI), which has become the most widely used tool to measure burnout. The MBI assesses burnout based on three dimensions: emotional exhaustion, depersonalization (or cynicism), and reduced personal accomplishment (or reduced professional efficacy).

Their work was crucial in helping to establish burnout as a recognized and studied psychological phenomenon. While burnout is widely studied and acknowledged in the field of occupational health, it is not recognized as a distinct mental disorder in diagnostic manuals like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). The World Health Organization (WHO) in its 11th Revision of the International Classification of Diseases (ICD-11) classified burnout as an “occupational phenomenon,” not a medical condition.

Core features

Burnout is characterized by three dimensions:

1. Emotional Exhaustion: This refers to feeling drained, fatigued, and unable to provide more of oneself at a psychological level. Workers may feel like they have no more emotional resources left to give, and they may dread what each day may hold in store for them.
2. Depersonalization or Cynicism: This refers to a sense of disconnection from others or from work itself. Workers may have a cynical or negative view towards their job, their colleagues, or their clients. They may feel as though they are going through the motions, rather than being genuinely engaged with their work.
3. Reduced Professional Efficacy: This refers to a decline in one’s feelings of competence and successful achievement in one’s work. Workers may feel like they are not accomplishing anything worthwhile or that they are ineffective in their roles.

Burnout can lead to a variety of negative outcomes, both for individuals and for organizations. For individuals, burnout can result in mental health issues such as depression and anxiety, as well as physical health issues such as headaches, gastrointestinal issues, or even cardiovascular disease. For organizations, burnout can lead to decreased productivity, increased employee turnover, and a negative impact on team morale and cohesion.

Employee turnover means the rate at which employees leave a company and are replaced. High levels of burnout can lead to increased employee turnover, as employees may decide to leave the job or the organization due to the high stress levels they are experiencing. Many parts of The UK’s National Health Service have experienced so-called recruitment and retention problems.

Employee turnover is often seen as a negative consequence for organizations because it can lead to several issues:

1. Costs: There are costs associated with hiring and training new employees, including recruitment costs, training costs, and the time it takes for the new employee to reach full productivity.
2. Knowledge and Skills Loss: When an employee leaves, they take with them the knowledge and skills they have gained, which can be difficult to replace.
3. Lower Morale: High turnover rates can lead to lower morale among remaining employees, who may feel uncertain or stressed about the changes.

Contributory factors

Burnout can be caused by various factors, often related to job design, organizational culture, and management practices. Some of these factors include:

• High workload and time pressure
• Lack of control over work tasks or environment
• Insufficient rewards or recognition
• Lack of social support
• Lack of fairness or justice in the workplace
• Conflicting or unclear job expectations
• Job insecurity

Some of the above will be explored later in this article.

Burnout or depression?

Burnout and clinical depression are distinct, although they can share some symptoms and one can potentially lead to the other if not addressed. It’s important to remember that while burnout is a syndrome resulting from chronic workplace stress, clinical depression is a mental health disorder that affects a person in all aspects of their life, not just work. Here are key differences:

1. Scope: Burnout is usually confined to the work context, while depression permeates all aspects of life. An individual experiencing burnout may feel negative about their job and experience difficulties performing work tasks, but these feelings typically don’t extend to other areas of their life. On the other hand, an individual with depression likely experiences consistent feelings of sadness, hopelessness, or a lack of interest in most or all aspects of their life, not just their work.
2. Symptoms: While both burnout and depression can result in exhaustion and reduced efficacy in work, depression also includes symptoms like significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, recurrent thoughts of death, and possibly suicidal ideation.
3. Duration and Intensity: Burnout can be seen as a chronic condition that develops over an extended period of workplace stress. Depression, on the other hand, can manifest as episodes that might be acute and intense, with symptoms usually persisting for at least two weeks for a diagnosis.
4. Treatment: Interventions for burnout often focus on changing the work environment or the individual’s relationship to it, such as reducing workload, improving social support at work, and enhancing job control. Depression is typically treated with a combination of psychotherapy and medication, and its causes can be more complex, often involving a combination of biological, genetic, environmental, and psychological factors.

Lastly, while the two are distinct, severe, untreated burnout can lead to symptoms that resemble those of depression, and chronic workplace stress can certainly contribute to the development of a depressive disorder. Anyone experiencing symptoms of burnout or depression should seek help from a healthcare professional for a thorough evaluation and treatment.

Economic impact

It is clear that the costs related to burnout are significant. Here are some general observations about the impact of burnout:

1. Direct Costs: These include healthcare expenses and costs associated with absenteeism (employees taking days off due to burnout-related illnesses). A 2020 study published in the journal “Annals of Work Exposures and Health” suggested that work-related stress and burnout led to approximately $190 billion in healthcare costs each year in the USA.
2. Indirect Costs: These are costs associated with presenteeism (employees coming to work but being less productive due to burnout), turnover, and the cost of hiring and training new employees. According to a Gallup study from 2017, the cost of turnover due to burnout could be between $450 and $550 billion per year in the USA.

As for the UK, a study by Deloitte in 2020 found that poor mental health (which includes conditions such as burnout) costs UK employers up to £45 billion each year, an increase of 16% since 2016. This cost is due to a combination of absence costs (time off work), presenteeism costs (reduced productivity at work), and turnover costs (recruitment and training of new staff).

Again, these are general estimates and the actual costs may vary. The costs are also likely to increase over time, especially given the additional stressors associated with events like the COVID-19 pandemic.

COVID-19 pandemic

There is evidence to suggest that burnout has increased during and after the COVID-19 pandemic. Several studies and surveys indicated a rise in burnout rates, particularly among healthcare professionals, essential workers, and remote workers.

1. Healthcare Professionals: The pandemic has placed an extraordinary amount of pressure on healthcare workers, leading to high levels of burnout. They have faced long hours, high mortality rates, fear of infection, and emotional distress. For instance, a study published in “JAMA Network Open” in July 2020 found that burnout symptoms were reported by more than 60% of frontline healthcare workers in New York City’s COVID-19 surge.
2. Remote Workers: The shift to remote work has blurred the lines between work and home for many people. Workers are putting in longer hours and dealing with distractions and challenges of home life while working, leading to increased stress and burnout. A study by FlexJobs and Mental Health America found that 75% of people have experienced burnout at work, with 40% saying they’ve experienced burnout specifically during the pandemic.
3. Essential Workers: Essential workers (those in roles critical to public health and safety, supply chains, and other key sectors) have also experienced high levels of burnout due to increased workloads, exposure risk, and the stress of keeping society functioning amidst a crisis.
4. Parents and Teachers: Parents, especially those working from home, and teachers transitioning to online learning platforms have also reported high stress and burnout levels due to the added responsibilities and the challenges of juggling multiple roles.

Remember that the specifics might have evolved since my last training update in September 2021, so for the most recent information, please refer to the latest research and data.

Detection of burnout

Detecting burnout can be challenging, as it often manifests in subtle ways before leading to more serious problems. Here are several strategies that organizations can use to identify burnout among their workforce:

1. Employee Surveys: Regularly conducting anonymous surveys can help organizations gauge employee sentiment and identify potential signs of burnout. Questions may focus on workload, work-life balance, job satisfaction, perceptions of fairness, and feelings of respect and recognition.
2. Performance Metrics: Burnout can lead to a decrease in productivity, an increase in errors, and a decline in the quality of work. By tracking these metrics, organizations may be able to identify employees or teams that are at risk of burnout.
3. Observation: Managers and supervisors should be trained to recognize the signs of burnout in their team members, such as increased absenteeism, decreased engagement, cynicism, and changes in mood or behaviour.
4. Open Communication: Encourage open dialogue about stress and burnout. This can be done during one-on-one meetings, performance reviews, or team meetings. When employees feel safe discussing these issues, they’re more likely to share their experiences before reaching a point of severe burnout.
5. Employee Assistance Programs (EAPs): EAPs provide resources for employees dealing with personal problems that might adversely impact their work performance, health, and well-being. They typically offer confidential assessments, short-term counselling, referrals, and follow-up services. Utilization rates and types of issues reported can provide insights into stress levels and potential burnout.
6. Mental Health Resources: If an organization provides resources like counselling services or mindfulness programs, tracking the usage of these resources can provide insight into the overall stress levels of the workforce.

Remember, early detection is key to preventing burnout from escalating. However, identifying burnout is only the first step – organizations must also be prepared to intervene and provide support to affected employees.

Organizational inertia

While it may seem counterintuitive, there are several reasons why organizations might not take adequate steps to address burnout, despite its impact on productivity:

1. Lack of Awareness or Understanding: Some organizations may not fully understand the concept of burnout, its causes, or its impacts. They might not be aware of how prevalent it is within their workforce or the extent to which it can affect productivity and employee health.
2. Short-Term Focus: Some organizations focus on short-term productivity at the expense of long-term employee well-being. While this approach might yield immediate results, it can lead to burnout and decreased productivity over time.
3. Culture and Stigma: In some workplaces, there’s a stigma associated with burnout, and it’s seen as a sign of weakness or lack of commitment. This kind of culture discourages employees from speaking up about their feelings of burnout, making it harder for the organization to recognize and address the issue.
4. Resource Constraints: Addressing burnout requires time, money, and resources. This includes investing in healthier work practices, employee support systems, and training for managers. Some organizations might not be willing or able to make these investments.
5. Misplaced Responsibility: Some organizations place the responsibility for managing burnout solely on the individual employee, emphasizing personal resilience and stress management techniques without addressing organizational factors that contribute to burnout.
6. Ineffective Leadership: Leaders play a key role in preventing and managing burnout. If they don’t prioritize employee well-being, don’t model healthy work behaviors themselves, or don’t know how to support their teams effectively, it can contribute to the persistence of burnout.
7. Lack of Concrete Strategies: Even if an organization is aware of burnout and wants to address it, they might not know how. There’s no one-size-fits-all solution, and it can be challenging to develop and implement effective strategies.

The above points represent organisational failures. At deep cultural levels such levels of inertia would have accumulated over many years. Organizations that perform poorly tend to continue along the same path. In other words dysfunctional organisations tend to breed burnout among workers over many years. It is wishful thinking  that such organizations would suddenly  wake up one day and correct the errors of their ways.

Cultural factors and burnout

The following cultural factors have been found to contribute to burnout. Not every organization where there is a high prevalence of burnout will feature each and all of the following. It is a matter of degree and persistence.

1. High-Stress Environment: Organizations that have high-pressure work environments, tight deadlines, high expectations, and long hours can contribute to burnout. This is especially true if these pressures are sustained over a long period without adequate time for rest and recovery.
2. Lack of Control: Employees who feel they have little control over their work, including their tasks, schedule, or resources, are more likely to experience burnout. This can be particularly stressful if employees are held accountable for outcomes that they feel they have little control over.
3. Insufficient Recognition and Reward: A lack of recognition for hard work, whether in the form of compensation, promotions, or even simple praise, can lead to feelings of being undervalued and contribute to burnout.
4. Lack of Fairness: Perceived inequity, whether in workload, pay, or opportunities for advancement, can also contribute to burnout. This can be particularly true in organizations where decision-making processes are opaque or seem arbitrary.
5. Poor Communication: When communication is poor, employees may feel uncertain about their roles, responsibilities, and performance expectations. This can lead to feelings of insecurity and increased stress.
6. Lack of Support: If employees feel that they cannot turn to their supervisors or coworkers for support when they are dealing with work-related problems, they are more likely to experience burnout.
7. Work-Life Imbalance: In some organizations, there’s an expectation that work should be the central priority in an employee’s life, leading to a culture that doesn’t support a healthy work-life balance. This can cause employees to neglect their personal needs, leading to increased stress and burnout.
8. Negativity and Conflict: A negative work environment characterized by cynicism, interpersonal conflict, or a lack of cooperation can increase stress and contribute to burnout.
9. Job Insecurity: Organizations where layoffs are common or job roles are frequently restructured can create an environment of uncertainty and fear, leading to stress and potential burnout.

Identifying the cultural factors that contribute to burnout within an organization can be challenging for several reasons:

1. Lack of Awareness or Understanding: As mentioned earlier, some organizations may not fully understand what burnout is, how to detect it, or how their culture might be contributing to it. They may not be equipped to connect the dots between certain cultural aspects and employee burnout.
2. Absence of Open Communication: In organizations where open communication is not encouraged or where there’s a fear of retaliation, employees may be hesitant to voice their concerns or stressors. This makes it difficult for the organization to get accurate feedback about burnout and its causes.
3. Underestimation of Burnout: Some organizations may recognize burnout as a problem but underestimate its prevalence or severity. This can lead to insufficient efforts to identify and address the underlying cultural factors.
4. Normalization of Stress: In some work cultures, high stress is seen as a norm or even a badge of honour. This can make it difficult to recognize when stress levels are unhealthy and leading to burnout.
5. Attribution Errors: There can be a tendency to attribute burnout to individual factors (like personality traits or poor time management skills) rather than organizational or cultural factors. This can lead to a failure to recognize and address systemic issues that contribute to burnout.
6. Lack of Confidentiality and Trust: Employees may be reluctant to share their true feelings and experiences if they don’t trust that their responses will be kept confidential or used to make positive changes.

Despite these challenges, it’s essential for organizations to make an effort to identify and address the cultural factors contributing to burnout. This can be done through anonymous surveys, third-party audits, or by fostering a culture that encourages open communication and values employee well-being. It’s a complex process that requires commitment and action at all levels of the organization, but it’s crucial for the long-term health of the workforce and the organization.

Reversing or arresting burnout

Individual strategies

1. Rest and Recovery: Multiple studies have emphasized the importance of recovery from work stress, both within the working day and during off-work hours. Breaks, vacations, and periods of rest have been associated with lower stress levels and better well-being. A 2012 study published in the Journal of Occupational Health found that sufficient recovery, such as relaxation and detachment from work during non-work time, can mitigate the negative impact of job stressors on health outcomes like burnout.
2. Self-Care Practices: Regular physical exercise and a healthy diet have been shown to improve mental health and reduce symptoms of stress and burnout. Similarly, adequate sleep is essential for cognitive functioning and overall health, and poor sleep has been linked to increased burnout. A 2018 study in the Journal of Clinical Psychology found that physical activity and healthy dietary habits were associated with reduced burnout among students.
3. Mindfulness and Stress Management Techniques: There’s a substantial body of evidence supporting the benefits of mindfulness for stress reduction and mental health. Similarly, stress management interventions, like cognitive-behavioural techniques and relaxation exercises, have been found to reduce burnout in various settings. A 2016 meta-analysis published in JAMA Internal Medicine found mindfulness-based stress reduction programs resulted in small improvements in stress/distress and the mental health component of health-related quality of life.
4. Seeking Social Support: Social support has been linked to better mental health outcomes and lower burnout in many studies. This support can come from friends, family, or colleagues and can provide an important buffer against stress. A 2001 study in the Journal of Applied Psychology found that social support, both at work and outside of it, played a significant role in mitigating burnout, particularly emotional exhaustion.
5. Professional Help: Psychotherapy, especially cognitive-behavioural therapy (CBT), has been shown to be effective in treating symptoms related to burnout. It helps individuals to identify and manage stressors more effectively. A study in the Journal of Clinical Psychology in 2017 found that Cognitive Behavioural Therapy (CBT) is an effective treatment for symptoms related to occupational burnout.
6. Work-Life Balance and Boundaries: In terms of setting boundaries and advocating for oneself, there is a growing body of research indicating that maintaining a good work-life balance and having autonomy over one’s work can reduce burnout. A 2010 study in the Journal of Vocational Behaviour found that inability to detach from work during off-work hours predicted higher levels of exhaustion over time.

Organizational strategies

1. Workload Management: A study published in the Journal of Organizational Behavior in 2001 found that interventions aimed at reducing workload and increasing job control were effective in reducing burnout.
2. Role Clarity: A study published in the Journal of Occupational and Organizational Psychology in 2005 found that interventions designed to increase role clarity (i.e., clear communication about job responsibilities and expectations) reduced burnout.
3. Social Support in the Workplace: A 2014 study published in BMC Public Health found that social support at work, from both supervisors and colleagues, was associated with lower levels of burnout.
4. Work-Life Balance: A 2017 study in the Journal of Occupational and Environmental Medicine found that an intervention focused on improving work-life balance resulted in lower burnout scores six months after the intervention.
5. Participatory Problem-Solving: A 2017 study in the Journal of Occupational Health Psychology found that interventions involving employees in problem-solving processes related to their work conditions resulted in lower burnout.
6. Organizational Justice: A 2016 study in the Journal of Occupational Health Psychology found that perceptions of fairness in the workplace (in terms of decision-making processes and interpersonal treatment) were associated with lower burnout.

Understanding these factors is the first step toward creating a healthier organizational culture that supports employee well-being and reduces the risk of burnout.

Concluding remarks

To truly address burnout, organizations need to recognize it as a systemic issue that requires a holistic and multi-level approach. This means creating a positive work environment, setting reasonable expectations, providing support, and promoting a healthy work-life balance.

Prevention and management strategies for burnout often focus on both individual and organizational levels.

On an individual level, strategies may include stress management techniques, mindfulness, exercise, adequate sleep, and maintaining a healthy work-life balance.

On an organizational level, strategies may include improving job design, increasing worker control, providing adequate rewards and recognition, promoting a positive workplace culture, and providing supportive management.

As burnout results mainly from organizational dysfunction it is difficult for individuals to recognise it and take control. However, there is some evidence that individual strategies can work. How effective they may be depends on a multitude of variables.

Ultimately, individuals who recognise burnout and the risks to their mental and physical health have personal responsibilities to themselves  and loved ones, to consider taking the option of changing jobs/organizations.

Recruitment and retention problems – high employee turnover – in the NHS are usually attributed to ‘national shortages’ of staff in various disciplines. Whilst that may be true, it masks other organisational problems. In other words national shortages become a convenient excuse for many NHS Trusts. As a result they are not motivated to look deeper or further into their own organizational competence.

Supplemental reading

1.  Addressing employee burnout: Are you solving the right problem? – McKinsey Health Institute, May 2022
2. 7 Strategies To Help Your Employees Avoid Serious Burnout – Forbes, Sept 2022
3.  The Best Way to Boost Workers’ Mental Health Is to Give Them Good Managers – Scientific American, Feb 2023