Getting serious about burnout: resilience has its limits

by TheEditor

Categories: Investigative, Mental Health, Rights

In a BMA article by Serene Boyd 21 May 2024 “Be resilient? What do you think I’m doing?“, Boyd says, “‘Resilience’ has become a loaded word. It is a quality everyone wants and needs, but is it right to tell doctors to be more resilient when it is their workplaces that are at fault.https://www.bma.org.uk/news-and-opinion/be-resilient-what-do-you-think-i-m-doing

Summary of key points:

  1. Personal resilience accounts for only about 20% of wellbeing at work, according to research by US haematologist Tait Shanafelt. Organizational factors and efficiencies of practice have a much greater impact on wellbeing.
  2. The focus on personal resilience puts the onus on the individual to cope, rather than addressing systemic issues in the healthcare system that contribute to a toxic work environment.
  3. Esprit de corps, or the connection with colleagues, is another major contributor to wellbeing at work, according to Prof. Shanafelt’s research.
  4. Burnout among health professionals is a widespread reality in today’s NHS, as confirmed by surveys and reports since the COVID-19 pandemic.
  5. Of more than 3,000 GP registrars polled by the BMA as recently as March, 72.9 per cent said they were experiencing burnout and stress. In April 2024, NHS England reversed its decision to cut specialist mental health support for secondary care doctors through NHS Practitioner Health, after an outcry, including from the BMA.
  6. The lack of a sense of team in the current healthcare system, in contrast to the past, is a significant problem contributing to burnout and stress.
  7. Team leaders play a crucial role in setting the tone of mutual respect and support, but they also need the resources and ability to create environments where their teams can thrive.
  8. Resilience training and techniques may have some benefits, but they should not be seen as a substitute for addressing the systemic issues that contribute to burnout and stress in the healthcare system.

This site has dealt with burnout before [Dealing with burnout 2023] but that doesn’t mean that it’s all been said before. A bit of repetiton is never a bad thing. Without doubt burnout is a mental health problem. Burnout is defined by the WHO, as a syndrome “resulting from chronic workplace stress that has not been successfully managed”.

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Scale and costs

Reliable cost estimates of burnout are not easy to find.

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, and other organizational 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]

Burnout or depression?

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. In UK law, no one to my knowledge and after extensive searches (which won’t be perfect), has been able to sue an employer for inducing burnout.

Burnout and clinical depression are distinct, although they can share some symptoms and one can potentially lead to the other if not addressed.

Table: Burnout v Clinical Depression.
FeatureBurnoutClinical Depression
Primary FocusWork-related stressGeneral feeling of sadness, despair, or emptiness. Excessive work related stress for prolonged periods can precipitate depression.
SymptomsExhaustion, cynicism, feelings of reduced professional efficacyPersistent sadness, lack of interest in activities, significant weight change, sleep disturbances, feelings of worthlessness
ContextPrimarily work environmentAffects all aspects of life
TreatmentChanges in work environment, stress management, work-life balance improvementsPsychotherapy, medication, lifestyle changes. Depression precipitated by excessive stress can respond to workplace changes. However, depression tends to linger as a separate condition even after changes.
OnsetGradual, often due to chronic workplace stressCan be sudden or gradual
DurationCan be long-term, but may improve with changes to work situation or environment. Episodes can last for several months; may be recurrent

Conclusions

Burnout is not depression though there may be an overlap of symptoms and signs. The former can lead to the latter.

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.

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.

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.

As burnout results mainly from organisational dysfunction it is difficult for individuals to recognise it and take action.

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


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