Why are we failing to solve burnout?

How would you make sense of the following vignette:

Over a 40-plus-year period, a disease (“X”) is diagnosed, its causes are defined, and effective treatments are prescribed
30-50+ percent of people working in your organization are currently suffering from X and cry out for relief
The stakeholders in your organization not only fail to apply best practices for preventing/curing X; they actually enable the drivers/vectors of the epidemic to intensify

As incredible as that all sounds, it is, in fact, the natural history of the occupational health syndrome referred to as “burnout.”
In 1974, Herbert Freudenberger observed a condition among workers in health clinics, which he described as a “state of mental and physical exhaustion caused by one’s professional life.”

Extensive research on the so-called demand-control model of burnout (aka “work strain”) demonstrates conclusively that when people (a) are required to manage a workload that exceeds their adaptive capacity and (b) do not have adequate decision-making control over how, when and where to do their work, they are at increased risk of developing serious health conditions such as anxiety/depression, substance abuse, cardiovascular disease and worse. Given that etiological pathway, delegating more decision-making power/control to the people who do the work is clearly the best way to decrease and even prevent work strain/burnout.

Given this massive program of research into the etiology and management of workplace burnout over the past 40 years, you would think the problem had been solved by now.

And yet, prevalence rates of burnout symptoms among physicians/nurses (as well as teachers and other workers) have lately soared to 30-50+ percent.

Failure 101

There are two main reasons that health care organizations keep failing to address the burnout epidemic: disengagement from the problem and using the wrong Dx/Rx.

Effective problem-solving requires the dedication of limited non-renewable assets such as time, attention, energy, and money. Most health care leaders are largely disengaged on a day-to-day basis from addressing the burnout challenge as they dedicate precious resources to more “important” matters of patient care and revenue generation. They convince themselves that they will deal with burnout once these top-line priorities are resolved, but they never are so they never do.

Despite the compelling evidence that burnout is largely caused by environmental and systemic factors, most health care leaders and human resource professionals remain enthralled by a person-focused “medical model” paradigm that locates problems “inside” of people. They, therefore, tend to prescribe person-focused interventions such as stress management (now called mindfulness/resilience) programs, therapy/coaching, and antidepressants despite their demonstrable ineffectiveness.

Rx: Change your mind/paradigm

The human brain resists abandoning familiar paradigms that provide a sense of understanding/meaning and control, even if those models of reality continue to drive them to apply solutions that don’t work. Fortunately, there are several robust alternatives to the person-focused medical model that can open up new and exciting pathways for understanding and dealing successfully with the burnout epidemic in health care organizations:

Public health/prevention model
Bio-psycho-socio-environmental model
Open systems model

Operating within the parameters of these models simply (albeit not easily) requires health care leaders and professionals to shift their focus from the individual/person level to the entire health care organization. As systems diagnosticians, they can apply their finely honed assessment/diagnostic skills to conduct the familiar review-of-systems (ROS) in search of relevant data on which to base an intervention plan.

But if the ROS isn’t focused on the blood pressure or stress level of the individual health professional, where should attention be directed?
In my work with professionals and organizations dealing with burnout, I have discovered five domains with which my clients are deeply engaged every day at work. Powerful beliefs are embedded within each of these domains, and the resulting actions are the proximal drivers/vectors of what I call “Hyper-Work,” a situation where work demands exceed the adaptive capacity of a person or organization:

Cultural (human software designed to answer key existential questions such as: What is real? What is good? How do things work here?)
Economic (beliefs/decisions about who deserves to get/keep the money)
Technological (beliefs/decisions about whose interests the machines should serve)
Organizational (beliefs/decisions about who has the power to make what decisions and what is important/valued)
Professional (the identity, values, core beliefs and preferred practices of the people who work here)

Entrenched belief/action patterns in each of these five sectors create a silent but powerful force field that drives people to work beyond their capacity and to remain largely silent about the suffering this Hyper-Work causes. Any attempts to directly challenge or change these entrenched patterns will generate powerful resistance, even from those suffering the most, unless those critical beliefs and attitudes are first excavated and disarmed.

To liberate themselves from the bonds of the self-defeating beliefs and practices that drive Hyper-Work, health care organizations must examine what everyone is really thinking and doing in each of the five domains above. So effective leadership in dealing successfully with the burnout epidemic will require the commitment and courage to stop and think (not easy to do in the hyper-working organization), to invest precious resources (time, attention, energy, money) in the service of gathering the right data on the right things, and formulating a plan to change for the better how the work of health care is done.