How the pandemic exacerbated burnout
Michael Leiter and Christina Maslach have been at the vanguard of burnout research for over three decades. They are the co-authors of “The Truth About Burnout” and a forthcoming book on burnout and work for Harvard University Press. Maslach is also a co-author (with Susan Jackson) of the Maslach Burnout Inventory, a widely used assessment with variants tailored for a range of populations. Leiter is a co-author of the version of the assessment used most often in organizations.
Their research shows that burnout is a workplace problem, not a worker problem. It happens when there is a bad fit — they call it mismatch — between an organization and its employees in one or more of the following areas: workers’ amount of control, fair treatment, a sense of community, workload levels, the doling out of rewards and organizational values.
Of course, there are plenty of burnout factories where employees are underappreciated and treated unfairly. But in most workplaces, under normal circumstances, employers and employees usually manage to find a healthier balance. This past year, the pandemic disrupted all of that.
We invited Leiter and Maslach to share their thoughts and observations about burnout in the era of COVID-19. What follows is an edited conversation.
How has the pandemic changed your thinking about burnout?
In our view, 2020 did not change what burnout is — it remains a syndrome of exhaustion, cynicism and inefficacy. If someone is experiencing high rates of all three of these at work, that indicates they are burned out, while low rates of all three indicate they are engaged. But although COVID hasn’t led to a redefinition of burnout, it has certainly aggravated it and the related forms of workplace distress. Many people are seeing an extreme intensification of their workloads and experiencing rising emotional difficulties and feelings of unfairness.
Does working from home put people at greater risk for burnout?
The risk varies, because people have been having so many different experiences. Remote work may have been a boon to introverts, people who thrive on long periods of uninterrupted work time, and those who hated their long commutes. But for most people, losing contact with colleagues and their day-to-day routines was distressing in itself, putting them at higher risk for exhaustion. Shifting into new modes of work and communication — say, suddenly being forced to teach a class online — can weaken one’s sense of efficacy as well.
What types of workplaces are being hit the hardest by burnout?
Health care is probably the industry suffering most disproportionately from burnout, for a few key reasons. Among people helping COVID-19 patients directly, an intense increase in workload has led to exhaustion. PPE shortfalls and an overall lack of preparation for this public health emergency have undercut confidence, contributing to cynicism. High rates of mortality and suffering have prompted people to withdraw emotionally. The lack of good evidence-based treatments has weakened people’s ability to feel effective. And to top it off, these conditions have persisted for months in many places and have reasserted themselves after a respite in others.
Essential workers outside of health care are also highly affected. They’ve been exposed to pathogens from the public and their colleagues, and PPE was quite slow to arrive. Some industries experienced disastrous outbreaks, such as meatpacking plants, which were some of North America’s worst hot spots last spring. Employees were working longer hours and worried about being infected, and they needed to adjust to new safety practices, with implications for exhaustion and inefficacy. They also felt unfairly treated at times because their low wages hadn’t changed, while others were receiving “hero wages” or unemployment payments.
What are you seeing about burnout globally? Are there meaningful differences between countries or cultures?
The experiences are more similar than different. However, some Asian countries, such as China, Japan and Korea, have had much more effective public health interventions. With their infection rates drastically lower than those in North America and Europe, these countries experienced fewer of the conditions that are aggravating burnout.
Michael, you have some new data from health care workers in Canada and Australia, two countries that did a fairly good job of stemming the virus throughout last year. What have you learned so far?
There’s an ongoing longitudinal study of licensed physicians in Canada that indicates the extent to which burnout is spiking among health care workers. In June 2020, the percentage experiencing burnout had risen to 23%, up from a pre-pandemic baseline of 14%. The engaged percentage fell from 36% to 27%. Remember that this is among all physicians — not just those on the front lines of the fight against COVID-19 — in a country that was doing relatively well when this data was gathered. It’s easy to imagine how much worse the numbers may be elsewhere. One bright spot was that inefficacy actually fell — by and large, physicians felt like they were still doing their work well.
Our survey of an Australian hospital that was a COVID hot spot last year found high levels of exhaustion and cynicism, mainly due to the inadequacy of preparation and a breakdown in trust. When you ask these workers to share their honest experience of work during this time, it’s heartbreaking. Of course, exhaustion was rampant, but words like “undervalued,” “demoralized” and “unfair” appear again and again.
One disengaged employee wrote that they felt dispensable in the organization. Another worker, who was experiencing full burnout, described a textbook mix of exhaustion, cynicism and inefficacy. Her team was getting different assignments on a weekly basis, bouncing from ward to ward. They were given mixed messages, never sure when their normal work would resume. They ended up feeling like pawns in someone else’s game. Perceptions of unfair treatment also simmered between patient-facing staff and those who could work remotely.
However, those employees who remained engaged often mentioned the benefits of working from home. Some credited their employer for being proactive in deploying PPE and taking a cautious approach.
What mistakes do organizations make when they try to measure burnout?
The biggest mistake is to focus exclusively on exhaustion or to use only a one- or two-item indicator. The worst method, which we see all the time, is simply asking employees, “Are you burned out?” These kinds of approaches are conceptually unsound, as they implicitly assume everyone has the same definition of burnout, and they don’t provide companies with any information on what specific problems to address.
These approaches are also limited in that they don’t differentiate between people who are truly burned out and those who are just feeling ineffective, are disengaged and cynical, or are overextended but are still involved and confident. Each category calls for a distinct course of action. For instance, if people are overworked and exhausted, what they need is time off or adjustments to their workloads. But if people are truly burned out, even if you give them less work, they’re not going to feel better. They won’t trust your motives; they’ll see the help as an indictment of their competence.
Another mistake organizations make, which we think borders on the unethical, is administering the measurement but then never following up, including failing to share the results with employees. That kind of action brews employee distrust to such a level that it’s probably worse than taking no action at all.
A lot of leaders misunderstand burnout, thinking it’s about an individual’s mental toughness. What do those leaders need to understand?
You can’t assume that this is simply a matter of better personal resilience or more-effective individual coping. Especially right now, experiencing burnout in no way implies any personal shortcomings. The more effective action is to support people while things are in emergency conditions, like the pandemic, and to redesign the workplace to provide a sustainable, effective and fulfilling work-life balance in normal conditions.
How can organizations help their employees bounce back from Covid-related burnout when the pandemic is over?
It’s important to note that not everyone who feels or appears to be burned out is experiencing the full syndrome. Feeling overextended from too much intense demand is a more straightforward thing to recover from than full-on burnout.
However, there are certainly those who are suffering from all three dimensions or may as the pandemic continues. To reduce the longevity of burnout in the post-crisis world, we suggest a few things.
First, recognize the contributions people have made in ways that are meaningful to them. As simple as it seems, a sincere “Thank you” or a gift of appreciation to all staff makes a big difference. Avoid singling out special or exceptional performances — who among us hasn’t been doing something special this past year?
Second, ensure open, honest communication between leaders and employees. This guarantees that people have a clear understanding of where things are going in the workplace, including how secure their jobs are. In addition to reducing ambiguity and confusion, this conveys respect and support: “We care about you, and we need everybody’s help to get through this successfully.” That sense of fairness, values and social inclusion will go a long way toward preventing cynicism and inefficacy.
Third, realize that things have changed. People have come up with new ways of doing their jobs that may help them work better post-pandemic. For example, you might accommodate a broader mix of people being off-site going forward. And consider that some of the tasks that did not get done during shutdowns may not need to be done at all in the future.
Relatedly, you should encourage people to do whatever works best for them to recover. Sleep is essential for everyone, of course. But the main thing is for employees to enjoy whatever activities help them feel better.
You’ll also want to publicly commit to serious planning for future crises. When people see their employer preparing for future emergencies, it reaffirms that you care about their well-being.
Finally, going forward, we should all consider new models of healthy work environments, including rethinking the hours and place of work as well as how our jobs get done. We need to take into account not just what causes burnout and what makes work harder for people but also what better place we want to get to and how we want to redesign organizations. It’s going to involve remaking workplaces in new, innovative ways.