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  • Anna Harrington

Focus on Burnout - WHO states cause; unmanaged chronic workplace stress.

Having worked in high risk burnout environments; intensive care, I have an emotional connection with this;  being witness to excellent and dedicated healthcare professionals diminish from being themselves personally and professionally. It is not just healthcare professionals who are at risk, I have seen the prevalence in other work sectors. 

Some consequences of burnout are prolonged sickness absence, employment change and those who remain in work; presenteeism, reduced work and organisation commitment and increase risk of errors.

This does not tell the whole story though; the deep sadness, confusion, anger and loss that is felt by the individual. Additionally it becomes a serious health concern when appreciation is given to links with ill health diagnoses such as depression, type 2 diabetes, cardio-vascular disease and premature death.

Recently the World Health Organisation (WHO) raised the focus on burnout through classing it as a syndrome but not a medical diagnosis, in it's 11th revision of International Classification of Diseases (ICD-11).

Being clear with cause, features and solutions is sometimes a difficulty in the provision of health advice usually due to a lack of quality research evidence.

With the case of burnout WHO are distinct on cause and features but the lack of quality research evidence on interventions impacts the clarity and specificity of guidance to prevent and resolve. Much of the research has focused on healthcare workers.


Cause & features of burnout are clear

WHO states it results from chronic workplace stress that has not been successfully managed. Details of this statement include facets of:

low job control

low workplace support

high job demands

role ambiguity

workplace conflict

Protective against burnout are high workplace justice and in intensive healthcare environments - further education.

Features or symptoms of burnout in the individual being:

feelings of energy depletion or exhaustion

increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job

reduced professional efficacy


Risk reduction interventions - a multidimension approach is best

What is less clear is the advice prescribing effective interventions and actions. This is due to burnout not being very amenable to a gold standard of scientific research - randomised controlled trials (RCT), research has focused on large or healthcare organisations and in my opinion the topic is of a very sensitive nature.

Businesses often attempt to improve and protect the mental health of employees through interventions targeted at the individual. Research assessing such interventions as cognitive behavioural training (CBTr), mindfulness (relaxation both physical or emotional), stress management have shown improvement in symptoms up to 6 months later but it is not certain how clinically relevant the improvements were due the assessing tool not having a level at which a change is accepted as being relevant and the low quality of the studies. This is further complicated by the effects being seen in 1 or 2 but not all 3 of the features of burnout.

The research evidence on organisation approaches has tentatively indicated that longer term improvements are more likely to be realised when compared against those only targeting the individual. But there is a paucity of quality research studies.

Public Health England evidence report centralising on "high risk individuals" lists effective organisation interventions such as:

An environment that promotes employee participation

Open communication

Manager and peer support

Encouraging employee learning

Employee participation in programme development

Other reported interventions such as:

Altering work patterns- number of hours and schedules

Have been found to have some risk reducing effects of burnout symptoms.

It has tentatively been agreed that a multifaceted interventions with both organisation and individual focus will have the greatest effect.

Just trying to increase employee resilience is very unlikely to have a good effect.


What to do?

Manage health and wellbeing at work; define, measure, plan, organise, implement and review. To know "what is right" in your organisation is just as important as "what is wrong" and I think often the "what is right" is ignored.

Factors such as being treated fairly, peer and line manager support can protect against burnout. A balanced perspective between individual and organisation systems is fitting.

Occupational health (OH) are experts able to assist you with the management of health at work. These professionals are capable of assessing needs and are profession bound to give you evidenced based advice. Bringing OH into your business with measurable objectives in addition to the reactive need for professional health advice to guide employee ill health management will assist to secure the health of your workforce and demystify a complex domain.

This article has been informed by the excellent features by Dr John Ballard in Occupational Health at Work on occupational burnout.

Anna Harrington

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