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. This article was followed by Getting serious about burnout: resilience has its limits (June 2024). Get interested: try the Well-being at work questionnaire (totally anonymously).

Get startled: The estimated total annual costs of absenteeism, presenteeism (attending work while ill, and so underperforming or being less productive) and labour turnover have increased by 25% since 2019, reaching an estimated annual total of £53-56 billion in 2020-21 (£43-46 billion in the private sector and £10 billion in the public sector). Read on!

There is a 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 is 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 is 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! It’s the same in everywhere in the NHS.” (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 work home. 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 recognised 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, depersonalisation (or cynicism), and reduced personal accomplishment (or reduced professional efficacy).

Their work was crucial in helping to establish burnout as a recognised and studied psychological phenomenon. While burnout is widely studied and acknowledged in the field of occupational health, it is not recognised as a distinct mental disorder in diagnostic manuals like the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). The World Health Organisation (WHO) in its 11th Revision of the International Classification of Diseases (ICD-11) classified burnout as an “occupational phenomenon,” not a medical condition. This means that burnout appears under QD85 of Chapter 24 of ICD-11 ‘Factors influencing health status or contact with health services‘ – not under Chapter 06 Mental, behavioural or neurodevelopmental disorders.

Core features

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 is 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. 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.

Burnout among doctors

The following are cited from “Burnout and psychiatric morbidity among doctors in the UK: A systematic literature review of prevalence and associated factors (BJPsych Bulletin , Volume 41 , Issue 4 , August 2017 , pp. 197 – 204). The review emphasised that burnout is a significant and persistent problem in the UK medical profession, with particularly concerning rates among junior doctors and certain specialties.

Economic impact

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

Scale: 40% of employees are experiencing moderate-to-severe burnout. 95% of HR leaders admit burnout is hurting retention at their organisations, contributing to up to one-half of annual workforce turnover. Companies with moderate-to-severe burnout have a 376% decrease in the odds of having highly engaged employees, 87% decrease in likelihood to stay, 22% decreased work output, and 41% decrease in the perception of the employee experience. [Tanners: Global Culture Report 2020]

Direct costs: These include healthcare expenses and costs associated with absenteeism (employees taking days off due to burnout-related illnesses). Employee burnout is costly: burnout is estimated to be attributed to 120,000 deaths per year and $190 billion in healthcare spending. This doesn’t include burnout’s toll on decreased productivity, an increase in errors, absenteeism, presenteeism, and other organisational costs. [Tanners 2020]

The estimated total annual costs of absenteeism, presenteeism (attending work while ill, and so underperforming or being less productive) and labour turnover have increased by 25% since 2019, reaching an estimated annual total of £53-56 billion in 2020-21 (£43-46 billion in the private sector and £10 billion in the public sector). [Deloitte 2020]

Indirect costs: Actively disengaged employees alone cost the U.S. between $450 billion to $550 billion each year in lost productivity, and are more likely than engaged employees to steal from their companies, negatively influence their coworkers, miss workdays, and drive customers away. [Gallup 2013]

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. There are several strategies that organisations can use to identify burnout among their workforce:

1. Employee surveys: Regularly conducting anonymous surveys can help organisations 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, organisations may be able to identify employees or teams that are at risk of burnout.
3. Observation: Managers and supervisors should be trained to recognise 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. Utilisation rates and types of issues reported can provide insights into stress levels and potential burnout.
6. Mental health resources: If an organisation 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 – organisations must also be prepared to intervene and provide support to affected employees.

Organisational inertia

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

1. Lack of awareness or understanding: Some organisations 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 organisations 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 organisation to recognise 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 organisations might not be willing or able to make these investments.
5. Misplaced responsibility: Some organisations place the responsibility for managing burnout solely on the individual employee, emphasising personal resilience and stress management techniques without addressing organisational factors that contribute to burnout.
6. Ineffective leadership: Leaders play a key role in preventing and managing burnout. If they don’t prioritise employee well-being, don’t model healthy work behaviours 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 organisation 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. Organisations 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 organisations 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 organisation 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: Organisations 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 organisations 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 organisations, 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 characterised by cynicism, interpersonal conflict, or a lack of cooperation can increase stress and contribute to burnout.
9. Job insecurity: Organisations 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 organisation can be challenging for several reasons:

1. Lack of awareness or understanding: As mentioned earlier, some organisations 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 organisations 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 organisation to get accurate feedback about burnout and its causes.
3. Underestimation of burnout: Some organisations may recognise 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. Normalisation 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 recognise 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 organisational or cultural factors. This can lead to a failure to recognise 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 organisations 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 organisation, but it’s crucial for the long-term health of the workforce and the organisation.

Reversing or arresting burnout

Individual strategies

1. Rest and recovery: Multiple studies have emphasised 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.

Organisational strategies

1. Workload management: A study published in the Journal of Organisational Behaviour 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 Organisational 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. Organisational 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 organisational culture that supports employee well-being and reduces the risk of burnout.

Concluding remarks

To truly address burnout, organisations need to recognise 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 organisational levels.

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

On an organisational 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 organisational 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/organisations.

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 organisational 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