American Association for Physician Leadership

Operations and Policy

Beyond Burned Out

Jennifer Moss

April 1, 2021


Summary:

In our always-on world, burnout has long been a threat. But in 2020 burnout became rampant, seemingly overnight. Within weeks millions of people lost their jobs and faced financial and food insecurity.





In our always-on world, burnout has long been a threat. But in 2020 burnout became rampant, seemingly overnight. Within weeks millions of people lost their jobs and faced financial and food insecurity.

When the Covid-19 pandemic began, I felt as if I were in one of those disaster movies, standing in front of a rapidly spreading fire as an entire city was about to be engulfed in flames. And despite feeling that a massive disruption was imminent, I could only watch in shock.

I’ve studied burnout and worked with organizations to address it for years, but nothing would inform my understanding of the topic more than living through 2020. For some time I’d been sounding the alarm: “Burnout is getting worse. People are sick!” Then we were all suddenly thrust into unknown territory: By April 2.6 billion people had gone into lockdown , and places of employment for 81% of the global workforce were fully or partially closed . A huge percentage of knowledge workers began doing their jobs from home — many collaborating on Zoom, whose daily active users skyrocketed from 10 million to 200 million . This sudden shift did what little else had been able to accomplish before: expose how thinly stretched and worn down we all were — and had been for a while. And it also made our burnout much, much worse.

Although the concept of occupational burnout originated in the 1970s , the medical community has long argued about how to define it. In 2019 the World Health Organization finally included burnout in its International Classification of Diseases , describing it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” This language acknowledged that burnout is more than just an employee problem; it’s an organizational problem that requires an organizational solution.

When you analyze the real causes of burnout, it becomes clear that almost everyone has been attacking the problem from the wrong angle. According to Christina Maslach of the University of California, Berkeley, Susan E. Jackson of Rutgers, and Michael Leiter of Deakin University, burnout has six main causes :

  1. Unsustainable workload

  2. Perceived lack of control

  3. Insufficient rewards for effort

  4. Lack of a supportive community

  5. Lack of fairness

  6. Mismatched values and skills

While these are all organizational issues, we still prescribe self-care as the cure for burnout. We’ve put the burden of solving the problem squarely on the shoulders of individual employees. “Let’s just recommend more yoga, wellness tech, meditation apps, and subsidized gym memberships — that’ll fix it,” we say. But those are tools for improving well-being. When it comes to preventing burnout specifically, they won’t be effective. We desperately need upstream interventions, not downstream tactics. In this article I’ll describe tactics companies can use to address some of the organizational roots of burnout.

Teaming up together, Leiter, Maslach, and David Whiteside, the director of insights and research at YMCA WorkWell, and I created a survey that analyzes the state of burnout and well-being during Covid-19. We combined several evidence-based scales, including the Maslach Burnout Inventory General Survey (MBI-GS), a psychological assessment of occupational burnout, and the Areas of Worklife Survey (AWS), which assesses employees’ perceptions of work-setting qualities that affect whether they experience engagement or burnout.

With support from Harvard Business Review, we gathered feedback from more than 1,500 respondents in 46 countries, in various sectors, roles, and seniority levels, in the fall of 2020. Sixty-seven percent of respondents worked at or above a supervisor level.

What did we learn, in a nutshell? Burnout is a global problem. Some stats:

  • 89% of respondents said their work life was getting worse.

  • 85% said their well-being had declined.

  • 56% said their job demands had increased.

  • 62% of the people who were struggling to manage their workloads had experienced burnout “often” or “extremely often” in the previous three months.

  • 57% of employees felt that the pandemic had a “large effect on” or “completely dominated”their work.

  • 55% of all respondents didn’t feel that they had been able to balance their home and work life — with 53% specifically citing homeschooling.

  • 25% felt unable to maintain a strong connection with family, 39% with colleagues, and 50% with friends.

  • Only 21% rated their well-being as “good,” and a mere 2% rated it as “excellent.”

The 1,500 people in our survey not only much more squarely fit the burnout profile than did the nearly 50,000 respondents who had taken the MBI-GS before the pandemic, they also scored very high on exhaustion and cynicism — two predictors of burnout, according to the MBI-GS. “These survey responses make it clear that a lot of people are having serious disruptions in their relationship with work,” Leiter notes. “It’s not surprising that people are more exhausted — people are working hard to keep their work and personal lives afloat. But the rise in cynicism is even more troubling. Cynicism reflects a lack of trust in the world. So many people feel let down by their government’s poor preparation for the pandemic, as well as by the injustices in work and well-being that the pandemic has highlighted.”

Millennials have the highest levels of burnout, we found. Much of this is due to having less autonomy at work, lower seniority, and greater financial stressors and feelings of loneliness. The last was the biggest factor leading to burnout, according to our research. As one Millennial put it: “The pandemic has had a tremendous impact on my well-being — I’ve had mental health challenges, and I’ve hit major roadblocks with that. My physical health has changed because I can’t exercise like I used to. It’s affected me economically. I feel as though my career has been set back yet again.”

How Did It Get This Bad?

So, yes, burnout is severe today, but the seeds were planted before Covid-19 hit — even then, many workers were already experiencing high levels of it. The pandemic was simply an accelerant.

Consider teachers. Pre-pandemic, they endured long hours and chronic underpay . Nurses and physicians, who have seen some of the most extreme cases of burnout, worked notoriously long shifts — often 16 hours or more, despite research showing that patient errors increase threefold when nurses (for example) work shifts lasting 12.5 hours or longer.

In other sectors — such as technology — overwork is celebrated, even though research clearly shows that putting in more than 55 hours a week does nothing to improve job performance. For example, in 2018 Elon Musk tweeted the following in response to a Wall Street Journal article describing Tesla’s culture of long hours: “There are way easier places to work, but nobody ever changed the world on 40 hours a week.” What number of hours is needed to change the world? “About 80 sustained,” Musk tweeted .

Former employees of Uber shared in 2017 that working until 1 or 2 AM was typical at the company , and a 2015 New York Times article about Amazon described “marathon conference calls on Easter Sunday and Thanksgiving, criticism from bosses for spotty Internet access while on vacation, and hours spent working at home most nights or weekends.”

It didn’t help matters that during the pandemic we misdiagnosed the resulting stress as acute rather than chronic. And once it was clear that the crisis was a triathlon, not a sprint or even a marathon, organizations did very little to help employees over the long term in meaningful ways, abandoning or failing to adapt their initial efforts.

In the first weeks of the pandemic, most organizations were expecting it to end quickly. Remote workers were given a return-by date of one month. Then another month. Then in May big tech companies like Facebook and Google extended working from home to the end of the year. (They have since extended it well into 2021.) In the meantime people were left to figure out their new WFH arrangements largely on their own.

We also saw a surge in “well-being by video,” as leaders scrambled to figure out how to replace the at-work experience with a virtual one. Team building now included Zoom happy hours and morning stretch sessions. In the first few weeks these virtual events were jam-packed, but within a month well-being measures just became part of the staff’s workload and there was no “happy” left in online social hours.

Several large-chain grocery stores in Canada and the United States chose to give their frontline workers “hero pay,” only to claw it back after a few months. (Some retailers are restoring it, but many have abandoned the policy.)

In the spring, physicians, nurses, and first responders were celebrated with parades and applause. Over time the cheers stopped. The applause faded at the worst possible time — when health care workers needed it most. They already had the highest rates of burnout, but the pandemic took them to unprecedented levels.

It’s understandable that we might not have recognized the true impact of the pandemic at first. So much was unknown. But once we realized we were in it for the long haul, we could have slowed down and analyzed what was working and what wasn’t. We could have been more creative about changing practices to ease burnout. But we didn’t. Instead of pumping the brakes when the virus spread and acute stress began to become chronic, we made things worse in these key areas:

We didn’t adjust workloads.

Overwork was the most-cited reason for burnout and decreased well-being in our pre-pandemic qualitative research. Research from Gallup has shown that the risk of occupational burnout increases significantly when an employee’s workweek averages more than 50 hours, and rises even more substantially at 60 hours. Clearly, this issue has not gone away. If anything, the pandemic has probably exacerbated it.

One respondent to our recent survey shared, “Everything seems like a rush. There’s more pressure to produce, and no one respects time boundaries. Emails start at 5:30 AM and don’t end until 10 PM, because they know you have nowhere else to go. For single people with no families, it’s worse, because you don’t get to say, ‘I need to go take care of my kids.’”

We didn’t give people control and flexibility.

The pandemic brought employees a host of new challenges. Childcare options were limited, with day care centers and schools closed and grandparents separated from their extended families. Parents were grappling with homeschooling children while working from home — with the whole family on the same Wi-Fi connection — and dealing with increased household chores resulting from suddenly having everyone under the same roof 24/7.

Some organizations saw the value of allowing employees more flexibility, but too many did not. I suspect this stems from the way the notion of flexibility has long been steeped in bias, with some considering it “a mother’s benefit.” The lockdown tested that idea, but in the end the existing systemic failures of workplace policies and biases about women proved disastrous. Gains for women would be lost, with serious consequences.

According to the Center for American Progress , “four times as many women as men dropped out of the labor force in September, roughly 865,000 women compared with 216,000 men.” Black, Latinx, and Indigenous women are experiencing this most acutely because of “the multiple effects of being more likely to have lost their jobs, being on the front lines as essential workers, and solving their childcare challenges on their own.”

“There’s no respite from work,” shared one woman in our survey. “I work 9 to 9 almost every day. My husband is working in the office, and I’m working from the kitchen counter, with the baby in the living room. I don’t get time to focus on anything. If I’m spending five minutes with my son, my instant messages are blowing up (and I hear the noise). If I’m working with my back to my son, I’m constantly turning around to check on him.”

The impact of the disruption to women’s ability to work is enormous. Even a 5% decline in maternal labor force participation would set women back 25 years, according to the report.

We allowed more meetings and unhealthful levels of screen time.

We talk about Zoom burnout as if it’s a new thing. In reality, it’s just a new manifestation of a bad workplace practice on overdrive. We’ve had meeting fatigue forever. According to Steven Rogelberg of UNC Charlotte, who wrote The Surprising Science of Meetings, pre-Covid-19 studies showed that about 55 million meetings a day were held in the United States alone and that U.S. organizations wasted $37 billion annually because most meetings were unproductive.

Despite all that, meetings increased substantially during the pandemic. According to a recent study sponsored by the National Bureau of Economic Research that analyzed the data on more than 3 million people, the amount of time employees spend in meetings has increased by 13% . In addition the average workday is now 48 minutes longer .

What’s especially troubling here is that video calls are actually harder on us physically and mentally. Our brains find it more challenging to process nonverbal cues like facial expressions and body language on them, making it tough to relax during conversations. Plus, slight delays in verbal responses subconsciously make us dislike people, according to research cited by Jena Lee, an attending psychiatrist and assistant professor at the David Geffen School of Medicine at UCLA.

“I sit all day. My ankles were swelling at one point, and I had to sleep with my feet elevated. I don’t sleep well. I have no time to do anything I enjoy,” one of our survey respondents told us. “I go from one Webex or Teams meeting to the next.”

We didn’t recognize the extent of people’s struggles.

Burnout, when experienced in the extreme, can be tragic. That’s what Corey Feist, who is outspoken on the topic of physician burnout, emphasized to me in the wake of his sister-in-law’s suicide last April.

Dr. Lorna Breen was the medical director of the emergency department at a hospital in Manhattan. She was working on the front lines, deep into the first surge of a locked-down New York City as the virus raged through it. Feist remembers Breen describing the hospital as “Armageddon.”

The factors that played a role in her burnout, according to Feist, are multifold. “First she contracted Covid-19 and was exhausted, depleted, and probably dealing with the brain fog that we now know impacts people with the virus. Then she went back into the workforce way too fast. On top of still being sick and exhausted, she would now face a volume of death and dying that she’d never seen before. Add in feelings around not being able to contribute and not being able to take care of your patients — because they were dying, and doctors are trained to fix people — and it was all so overwhelming.”

Not every case is as distressing as Breen’s. But her story points to a key truth: One big problem of the pandemic is that we simply haven’t realized — much less acknowledged — how hard circumstances are. And we’ve been applying Band-Aid solutions to a gaping wound in the form of yoga programs, wellness technology, and meditation apps. The need to recognize that people are working unsustainably day after day, that they may not feel safe talking about their mental health, and that they’re overwhelmed and exhausted is urgent. There is no app to fix that.

And the vast majority of senior leaders have told us that they’re tired, too — and tired of leading tired people. This global pandemic is not “business as usual,” so we need to stop acting as if it is.

How to Beat Burnout

There are some easy things we can all do to combat burnout, most critically at the organizational level. There was good news in our research, and it illuminated where we need to focus. Factors that predicted lower levels of burnout included the following:

Feeling a sense of purpose.

Respondents said that this feeling helped defend against burnout at work. In fact, burnout scores declined as purpose scores increased: Twenty-five percent of people who felt a strong sense of purpose in their work had not experienced any burnout (according to both self-reporting and the MBI-GS) in the previous three months. However, since the data reflects knowledge-worker sentiment, I wouldn’t want to suggest that employees on the front lines or first responders should rely on purpose to prevent burnout. This finding requires more analysis, but my colleagues and I found it to be an important insight.

Having a manageable workload.

This was one of the strongest predictors of lower burnout. To help overburdened employees, organizations should communicate more about priorities and about what can be put on the back burner until time permits (or perhaps forever).

One of the most glaring issues related to workload was meeting fatigue — it tops the list of things organizations must tackle. To begin to address it, use this simple formula:

  1. Ask, Is this meeting necessary?

  2. If yes, then ask:- Can we do an audio-only conference call for a much-needed screen break? Does it have to be a video call?- Does it have to be longer than 30 minutes?- Which attendees are absolutely essential?- Can we turn off our cameras and use our photos or avatars instead?-

  3. Start meetings with a check-in: How are people feeling? Does anyone have a back-to-back call? If you’re leading the meeting, set a timer so you can let anyone who does have one jump off five to 10 minutes early.

Feeling that you can discuss your mental health at work.

Our survey found that nearly half of respondents don’t believe they can openly do this — and 65% of those people experienced burnout “often or always.”

That is a massive problem.

The first step toward solving it is to create a culture of psychological safety at work, which Harvard Business School’s Amy Edmondson, who is an expert on the topic, defines as “a climate in which people are comfortable being (and expressing) themselves.”

For example, when someone messes up, we may get angry. Yes, we all have a right to be frustrated, but whom does that serve? The bigger goal is to set things right. Edmondson suggests that more-productive responses start with asking about what help is required to get back on track. That is, after all, what we really care about. When this kind of communication is common, people generally feel safer talking about more-personal topics, like mental health.

Another tactic is to offer employees access to mental health support. That could include:

  1. A mental health resource page listing local outreach programs and mental health practitioners that are cause- or crisis-specific.

  2. Reduced hours, flexible hours, or even paid time off for anyone who has mental or physical health concerns — or who is caring for a loved one affected by the crisis. We were dramatically caught off guard by the pandemic. This can’t happen again — time off and grief policies should be readied now.

  3. A peer-to-peer outreach program. Firms can select leaders to train in mental health 101, who can then be activated as a support system for the staff in a crisis.

  4. Having managers check in on their direct reports immediately. The pandemic was a jarring example of how quickly a crisis can escalate. If we have communication plans in place before disaster hits, we can provide answers to pressing issues. Just by asking more frequently “How are you doing?” and “How can I help?” we’ll demonstrate that the well-being of our team is a priority.

Having an empathetic manager.

This was the second-most-cited need in the survey, just slightly behind manageable workloads. And for good reason: According to Harvard Medical School’s Helen Riess, who is also the cofounder and chief scientist of Empathetics , communicating empathically increases job satisfaction, reduces burnout, and is highly correlated with enhanced well-being . It is perhaps the most critical skill in a crisis and something that we can all improve on.

Empathetic leadership requires three things: acknowledging and overcoming any personal biases and privileges you might have; actively listening to your people; and taking action. I want to focus on the second — active listening — as something that’s particularly important today. It involves giving people a safe place to share and demonstrating that you’ve heard them by acting on their words. You can do this one-on-one or set up open forums through Slack or Teams or any other workplace social collaboration tool, where good ideas can proliferate. You may also want to create the opportunity to provide anonymous feedback; there are survey tools out there that make it easy to do that.

Another unique way to combat burnout is to become a “professional eavesdropper,” according to Martha Bird, a business anthropologist for the data processing company ADP. Why? Because it’s often the small things we say and do over time that account for the bigger picture on our well-being. “People are messy, and the messiness is what tells us the most,” she told me. “We humans attempt to make the mess meaningful. And that meaning is reflected in what we do.”

Bird is suggesting that we need to look deeper than an occasional “How are you doing?” One study found that on average an adult will say “I’m fine” 14 times a week, though only 19% of people really mean it . Almost a third of the 2,000 people in our survey said that they often lie about how they’re feeling. By paying closer attention to what your employees are talking about and seeing patterns, you can spot and head off problems.

So the next time people say they’re fine, ask again, “Are you really fine? It’s OK if you’re not. I’m here if you need to talk.”

Having a strong sense of connection to family and friends.

Our survey highlighted how many of us feel isolated. Before offices went virtual, one of the most healthful benefits of work was that it allowed us to establish and build friendships . That’s much more difficult, if not impossible, to do remotely.

“I started this job six days before the pandemic meant that we had to work from home. I found it challenging to connect with new colleagues over Zoom calls,” one survey respondent wrote. “Even when I do go to the office, we are not allowed to meet in person. I think I have spent a total of about 10 hours face-to-face with my colleagues, and maybe 40 to 60 hours in Zoom meetings with them. It’s hardly enough to build trust and respect in a way that would feel meaningful to me.”

Personally, I think some companies went too far too fast by making work from home a “forever” policy. Nearly three-quarters of employees want to have access to an office, according to a recent JLL survey of more than 2,000 employees across 10 countries . And 80% of high performers have missed their office greatly during lockdown, according to the same report.

Flexible options are what workplace experts have long been arguing for. As soon as it is safe to do so, we need to create hybrid solutions that allow coworkers to connect and collaborate in person and virtually.

Rich Barton, CEO of Zillow, has chosen to offer both work-from-home and in-office options. “The way our team delivered after we went remote turned my legacy opinion of working from home on its head and began a journey toward letting our people decide where they will thrive and be the most productive,” he told me.

The best relationships are still built when we can see one another’s faces in person. The need to socially distance for almost a year now has taken a toll. So once the pandemic’s risks subside, leaders need to find ways to bring their teams back together in a physical space to connect in real life.

Prepare Before the Next Crisis

Of course, this is all just a starting point for how companies can address burnout. But the point I want to hammer home is this: Leaders, get the right systems in place now, before the next crisis happens.

I’ve found that the companies that were already engaged in a burnout prevention strategy have been more successful at leading their workforce through the Covid-19 crisis. And I’ve been pleasantly surprised by the number of leaders who were deeply motivated to support their workforce. Here is one example that stood out for me.

Alan May is the executive vice president and chief people officer for Hewlett-Packard Enterprise (HPE). I spoke with May in October 2020, when nearly all the company’s 60,000 employees were working remotely. He believes HPE’s long-standing commitment to well-being has helped it weather the year’s challenges. “Crises tend to just accelerate underlying trends,” he observed. He hasn’t been creating wellness programs only in response to Covid-19; when it hit, the company was already two years into an internal campaign focused on them.

Long before the pandemic, HPE was addressing burnout. One of the examples May shared was having “meetingless Fridays” to create “white space” for employees to work on ideating or reflecting. He also reinforced the importance of having frontline managers check in with employees regularly. While he’s not expecting those managers to be mental health experts, he shared that “in a number of cases, as a result of some of those interactions, we’ve detected some concerns, and we’ve been able to escalate them and get more professional help.”

May also had created virtual social chat groups for peer-to-peer communication, where leaders could also actively engage, to bring together like-minded individuals with no real objectives. “We didn’t proctor the groups, but we did participate to some extent by listening,” said May. And when the crisis hit and “employees started sharing specific tips and tools for others working at home or specific suggestions for those that were homebound and lonely, it just became all about lifting up those good ideas and executing on them.”

The resilience HPE employees appear to have built up seems to have served them well during the pandemic. According to the firm’s “Employee Work Experience Data” from July 2020:

  • 91% of employees agreed that employee health and well-being was a top priority for HPE.

  • 92% agreed that their direct leaders had shown genuine concern for their well-being.

  • 91% agreed that their direct leaders had shown flexibility by allowing them to balance their personal and professional lives.

Employee experience scores like these send an important message: “We feel supported. Keep it up.”

If your organization also wants to foster great workplace experiences, well-being must be table stakes. Put mental health and burnout prevention protocols in place now. Prepare a communication strategy well in advance, so that when another crisis hits, information about support programs and details on any new health and safety measures can be shared instantly with employees. Keep in mind that poor communication during the Covid crisis has been a primary regret for more than a third of C-level leaders — and that 32% of employees surveyed claimed they yearned for more communication, done sooner and more transparently.

There is no quick fix for any of the burnout issues we’re facing, and sometimes that can feel paralyzing. We need to start small, or the task will seem too overwhelming. Big change starts with modest practical steps, working toward collective change.

We can’t waste this crisis. The well-worn phrase “Knowing is half the battle” feels applicable here. If we can identify organizational signals of stress — because we are finally paying attention — then there is hope for the future.

Leaders, we have endured a trial by fire, and there’s no turning back. We did not experience this crash course in emotional flexibility — this testing of our resilience — only to squander the learning. We have a shot at truly preventing burnout, and we can’t say that it’s too hard or too much work or that it requires too much change. The best moment to make a move is when everything is up for grabs. It’s time to turn the change that was inevitable into the change that was always possible. Starting right now.

Copyright 2021 Harvard Business School Publishing Corporation. Distributed by The New York Times Syndicate.


Jennifer Moss

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