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Managing and Preventing Burnout in the Workplace video transcript

Video transcript of Mental Health Community of Practice – Managing and Preventing Burnout in the Workplace July 2021.

Watch the video of the Comcare webinar.

Natalie Bekis

Good morning, everyone, and welcome to the Mental Health Community of Practice. I’m Natalie Bekis, General Manager of Comcare’s Strategic Partnerships and Engagement Group, and I’ll be your host for today’s event. Firstly, I’d like to acknowledge the traditional owners of the lands on which we are all virtually meeting today. I’m in Melbourne. I would like to acknowledge the Wurundjeri people in the Kulin Nation and the traditional custodians on the lands on which we are all meeting. I would like to pay my respect to Indigenous Australians and Torres Strait Islanders, elders past, present and emerging, to acknowledge the contribution they make to this nation, and extend that respect to all Indigenous Australians and Torres Strait Islander people attending this event today.

Comcare’s Mental Health Community of Practice brings together a wide variety of people from across our jurisdiction, including workplace leaders, human resource and health and safety practitioners, as part of driving better practice and creating mentally healthy workplaces. For those of you attending for the first time, a very big thank you for joining us, and for returning attendees, welcome back. It’s great to have you with us today. We have over 200 people who have registered for this event today. Although we are not gathered in Comcare’s offices across Australia, which, I’ve got to be honest, we originally had planned and had hoped for, we are delighted to be gathering virtually to discuss the management and prevention of workplace burnout.

So what actually is burnout? We hear a lot of discussion and consternation about it, but far too often burnout’s true causes and effects are overlooked or oversimplified. Burnout is now recognised as an occupational phenomenon in the World Health Organisation’s International Classification of Diseases. The WHO defines burnout as “a syndrome in which – resulting from chronic workplace stress that has not been fully managed and is characteristic by feelings of energy depletion or exhaustion, increased mental distance from work, or feelings of negativity or cynicism about work and reduced professional efficacy.”

In the Australian Public Service Census conducted in October 2020, members of the APS were asked to what extent they agree with the following statement: “I feel burned out by my work.” Over 100,000 APS employees responded. Twenty-seven percent said that they agreed with the statement, and nine percent said they strongly agreed, so if we just do the maths, that’s a staggering 36 percent of respondents, or more than one in three, answered in the affirmative. That was the first time this question had been asked in the Census, so it will be interesting to see the results of the 2021 Census which are due for release in the next month or so.

Today we’ll hear from three wonderful presenters about how we can better define, understand and ultimately aim to prevent and manage burnout in the workplace. After our presentation, we’ll have some time for questions and answers. If you would like to ask a question, please submit that via the chat function, which is accessed by clicking the question mark icon on the top right-hand corner of your screen. We will also be using the chat function to conduct some polls throughout the event. If you’d like to participate, all answers are anonymous, and you can simply give a thumbs up or down to the most relevant answer to you.

The first question is now going in the chat now. We are excited to have people joining us from across Australia, and we are wondering have you attended one of Comcare’s Mental Health Community of Practice events before, so I’ll leave that question to go in the chat, and we’ll come back to that answer a little later. While this event is designed to be informative and helpful, we want to acknowledge that mental health related discussions can often be difficult and may give rise to concerns for some people watching. We’d like to remind you that everyone has access to the following services, and they should be coming up on your screen now. Excellent. Thank you to my team.

Links to a selection of these supports will also be available and posted in the chat function, so you can easily click on the link and have access to those supports as well. Unfortunately, Comcare’s CEO, Sue Weston, is unable to join us today, but she has asked me to provide a bit of a brief overview of Comcare’s mental health initiatives. So firstly, most of you are aware that Comcare is leading the implementation of NewAccess workplaces in 16 APS agencies. That work was done following a successful pilot, so we now have that service available to 120,000 Commonwealth employees, so access to mental health coaching in the workplace and low intensity CBT.

So where are we up to? We’ve had over 1000 enquiries to the service. We’ve had over 600 people who’ve accessed mental health coaching through the NewAccess workplace program. An interim evaluation program is underway with PwC, and so really shortly in the next couple of months I will be able to share the interim results in terms of what we’re seeing, not only on utilisation but recovery rates, but also stressors and giving us a bit more insight in terms of what are the pressures that people are facing within their workplace but also without, and remembering that this program is available for both work-related and non-work-related issues or challenges that people may be having.

Secondly, some of you who might follow us might have seen that we have recently released some information – evidence-based guides around the better practice use of EAP services. One of the gaps that we’ve been discussing for quite some time – and that was also noted by the Productivity Commission – is around evidence-based used of EAP, so we’ve developed two resources. One is a fact sheet around the principles of effective EAP, and the other is a monitoring framework that is now available and – available on our website, but also you can see us on LinkedIn as well.

And finally, for those who attended the Mental Health Community of Practice event in November last year, will know how critical it is that workplaces tackle mental health stigma that may prevent workers from seeking help. We are in the process of developing a workplace communication strategy that will support leaders to improve mental health awareness and reduce stigma in workplaces. We’ll keep you updated as this initiative unfolds. So moving on now, I would also like – if you would like to also learn more about Comcare’s work to support mental health and wellbeing in our scheme, please reach out to the Mental Health and Research Team. Their email address will go in the chat function too, and my team can be in contact with you and provide you with the necessary support.

So let’s take a look at the thumb poll. I’m just getting up the results now. So it’s pretty even. If we have a look across the board, we’ve got lots of new people joining, and we’ve got lots of new people who are returning, so wonderful to see so many of you online today and remembering that these resources will be available after this event on our website too. So let’s – now to our first speaker. Let’s not hold this event up any longer. I’m really pleased to introduce Professor Christina Maslach, who is kindly joining us from San Francisco. A humungous thank you to Christina for taking the time to join us today.

Professor Christina Maslach is a Professor of Psychology and a core researcher at Healthy Workplaces Center at the University of California, Berkeley. Christina is a pioneer of research on the definition, predictors, and assessment of job burnout. She created the Maslach Burnout Inventory, the MBI, as a standard research tool for studying job burnout and has written numerous articles and books, including The Truth About Burnout. Thank you for joining us to explain workplace burnout, Christina. So over to you now.

Christina Maslach

Well, thank you very much for inviting me. I wish I could be in Australia, quite frankly, rather than here, but this will have to do, and I will do my best to share, kind of, the basic lessons that we have learned about burnout in the workplace over the past several decades, and “we” meaning many other people around the world who have been doing research, as well as myself and my team. So let me just briefly start again with what was just given as the World Health Organisation’s statement on burnout, and this came out two years ago in 2019. And so the first part of that definition is that it’s a syndrome resulting from chronic workplace stress that has not been successfully managed, and what’s important are two things here.

One is chronic workplace stress. This is not occasional stressors. This is something that happens frequently. You’re facing these stressors everyday or most days of the week, and chronic stressors have a greater toll on human beings than occasional acute workplace stressors. So this is an important thing, this frequency that characterises burnout. The second thing to point out is that it says it has not been successfully managed, so unmanageable sources of stress, and the question is, well, who or what should be managing it? World Health Organisation have said, essentially, all possibilities are there, so they’re not saying that it’s just the responsibility of the individual worker or the team or the organisation. All of them have a role to play.

So burnout is characterised by three dimensions. The first one is the exhaustion, energy depletion, and this is the stress response, so it is a stress response to chronic workplace stressors, but that’s not all burnout is, and I think some people think it’s just the stress. But there are two other things that go on with burnout. One is this cynicism, this negative, “take this job and shove it,” you know kind of feeling about the people you work with, the tasks you’re doing, the way the organisation is run, and when this begins to set in, then people are really not trying to do their very best. Instead, they’re trying to do the bare minimum, “What is the least I can do and get out of here and still get a paycheck?” So for me this is really the more critical component of burnout, is this cynicism, this negativism and pulling yourself away from the work.

And finally, there is the outcome of – or you know the dimension of burnout which is a negative sense in oneself. You’re not really feeling you’re doing as great a job as you could, or even begin to think you’ve made a mistake to do this kind of thing or be here in this particular job, so it’s a stress response with a negative, cynical response to the job, and then a negative evaluation of oneself, and so that trifecta all together is what makes burnout so critical.

The World Health Organisation, as mentioned earlier, talks about this as an occupational phenomenon and specifically said it is not a medical condition, and this is from the World Health Organisation and their classification of diseases. They’re saying burnout is not that. It’s not a medical condition, but many people treat it as though it were and want to diagnose people and give them medication and all of this kind of thing, but it’s not. It’s not classified as a mental illness. In the United States, the American Psychiatric Association, which oversees you know the definition of mental illnesses, has specifically said no, that burnout doesn’t fit. It’s part of human condition, of how people respond to stressors. It can have health consequences, as we will see a little bit later, but it in itself is not a medical condition.

So one important lesson that has come out from a lot of the research is that both the person and the situation are involved here. There’s a lot of, you know, back and forth. Is it the person who can’t handle the job? Is it just a lousy job? It’s both. It goes together. So you’re talking about burned out people and the experience they have, but you’re also talking about what’s going on in the job environment that’s causing this kind of response in workers. So it’s really about a match or a mismatch between people and their job, and that relationship between the job and the person is really a much better way of understanding what’s going on and leading us to a better way to do something about it.

So let me just talk about what burnout is and is not. As I said before, it’s a pattern of all three of these dimensions: exhaustion, cynicism, inefficacy. What is it not? It is not just one of those three things, and people often say if it’s just exhaustion, that’s burnout. If it’s just you’re not feeling good about yourself, that’s also burnout. No. It’s really the three together that characterises this. As I said just before, it is not a psychological disease or a clinical deficit, but research has clearly shown that it can be a step along the way toward feeling depressed, feeling anxious, having other kinds of health problems and so forth. So it has health implications, but in and of itself it is not a disease.

It is not diagnosed by some score on a test that says you’re either burned out or you’re not. There has been no clinical research that has established that kind of thing, and as I said before, it’s one of the reasons both the World Health Organisation and the Psychiatric Association in the US have said it’s not that kind of thing.  People use the term burnout. It’s very catchy. It’s got great imagery, but they use it as a synonym for all kinds of other things. So as Natalie was saying before, it’s not always clear that people are you know talking about the same thing. People say, “I’m so burned out on jogging, you know. Maybe I’ll try Pilates at the gym,” or, “I’m like a burned-out light bulb. I haven’t had a good idea in a week,” you know or something. So we really have to be careful that the term kind of can get overused and stretched beyond what you’ve been able to identify about it.

So from my point of view, looking at all of this work, burnout really says more about where people are working than it does about them, even though that may seem counterintuitive, because they’re the ones experiencing it and having the problem. But it’s really more analogous to the canary in the coal mine, and if you think about that, the canary – there’s the human thing that is let down into the mine, or used to be let down into the mine, and if the canary could not function well and had trouble breathing, that was a sign. It was a flag, red flag. It’s a warning this is not a good environment. Other human beings should not go down into it. We’ve got to fix it. There’s toxic fumes that need to be fixed before people enter it.

So burnout, in some sense, is really a sign to a lot of us that what’s going wrong in that relationship between workers and the workplace, and it’s as much about fixing the workplace as it is about, quote, fixing the people. So there are measurement issues in all of these kinds of thing. There’s lots of measures of burnout. As I say, they differ. How they’re worded, what they do, etcetera, they’re not comparable, so it’s not – if you use this one and you use that one, you’re going to get the same kind of information. Some have not been validated.

They may sound good, but we don’t know that they really work well, and because of the stigma that’s always still attached to burnout, people may not want to actually give true answers, especially if they’re asked to fill out questions about burnout and there’s not confidentiality, because if you have been targeted as someone who is having problems, who is burned out, there can be a lot of negative consequences from your colleagues, from your organisation and so forth about that, so people don’t really always want to talk about it, and that means that there’s always a challenge in terms of getting an accurate picture of, you know, how much burnout is out there and where is it and who is suffering and so forth.

The measure that I developed back in the ‘80s is the Maslach Burnout Inventory. It’s a research measure, but a lot of people are wanting to use it as a diagnostic. You take the test, and you’ll find out if you’re you know sick and ill with burnout. It is the only measure to assess the three dimensions that are in the definition of burnout according to WHO, but what – it also differs from a lot of measures because it’s getting at the frequency. It’s asking how often are you experiencing this kind of thing, and for burnout, when we talk about high negative scores, we mean highly frequent scores on those three dimensions. So people are feeling this way several times a week, every day.

It’s not occasionally, you know, so if you’re feeling like, “I’m not doing so good at work right now,” and that happens maybe a couple of times a year you know like that, that’s not burnout. That’s kind of normal life, but if it’s a really constant frequent kind of thing, then you’re in burnout territory. But it turns out that those three scores can produce different patterns or profiles, so there are different work experience and people again pay usually just attention to burnout or not, but the not includes four other options.

So the first one is burnout. This is where you have highly frequent negative scores on each of those three dimensions. But there are people who can be high on just the cynicism. They really are not happy with the workplace and the job and whatever, but they’re not exhausted, and they think they’re doing a good job, so they’re showing something very different, and we call that disengaged. There are other people who are having a problem with exhaustion. They are tired. They are worn out all the time, but they still feel good about their job. They still feel good about themselves. These are what we call the overextended group, and often people think this is burnout as well, but actually I’ll show you later it’s not.

Then there’s people who are only high on their self-evaluation. They don’t feel so great about their work and what they’re accomplishing and moving forward, but otherwise they’re not exhausted, and they – and you know they think it’s a good workplace to be in. They have a different kind of pattern of work. And then finally you get engagement, which is you’re not experiencing any of those three negative things. In fact, you’ve got really three positive scores, and that’s your high frequency, is positive, and we talk about that as being engaged with the job.

So what we have found, if you look at samples of the workforce and say how many people are experiencing these different things, you’ll get something that looks like this, very typical – these are positions – or a sample of positions throughout North America, but pre-pandemic, I have to add, so things may look a little differently now, but before that, as you can see up in the upper left, 15 percent of these physicians were scoring as burned out on all three dimensions, and about twice that amount – almost 30 percent – on the upper right, the green, engaged, and 30 percent of the workforce being engaged is very, very typical, not only in our surveys but in Gallup Employee Engagement Index and all these kind of things. It’s a fairly consistent pattern.

Now, the other three, if you’re going to the left here, the blue one, this is the disengaged, high cynicism only. The yellow is the high exhaustion only, over-extended, and high ineffective, self-efficacy is low. That’s the pink one. Sometimes the problem is that people view everything outside of engagement as being burnout. Like, “Well, you’re exhausted, but not the other, but you’re still beginning to show signs of burnout.” If you start doing that, you’re ending up with 70 percent or 50 percent of the population is quote burned out, when in fact only 15 or 20 percent are showing that. So this is where we get some really funny numbers that people will make claims about by lumping everything together when they really shouldn’t. It’s a different pattern.

What’s important to look at is, as I mentioned before, the job person mismatch, and where are those occurring in that relationship between the worker and the workplace, and there are six areas that have been identified so far as being predictive if there is a mismatch of greater risk of burnout. One of them is workload, demand overload. You have way too much to do and not enough resources to get it done, not enough time. You don’t have the right tools. You don’t have the people you need, etcetera. So the imbalance, the mismatch is between the high demands, low resources, and this is the mismatch that is probably closely – most closely linked to exhaustion alone. But there is others.

There’s a lack of control. When WHO talks about stressors that are unmanaged, not successfully managed, we’re talking about lack of control, and you’re not able to work with those effectively to reduce the problem there. Another area that’s really critical is insufficient reward, meaning positive feedback when you do something well and you do a good job. If you’re working in an environment where the best thing that can happen is that there’s no disasters, but there’s nothing positive, that’s a very difficult work environment, bad mismatch.

Breakdown of community – by this we mean the workplace community, your colleagues, your boss, the people you supervise, your clients or customers or you know students who are – people that you work with regularly, like vendors or other kind of thing. And breakdown of community means there’s a lack of trust. There’s no support. People are out to get each other, put each other down. There’s bullying you know in some circumstances. It’s a socially toxic environment in which to work, and we’ve been seeing an increase in these social toxic workplace communities even before the pandemic, so this has been a real concern of late.

Another big area of mismatch is an absence of fairness: the idea that whatever our rules are and our procedures, we don’t apply them fairly. This is where glass ceilings exist and discrimination, where people are held back and not given the opportunities that might be – should be coming to them, where people are cheating you know to get ahead and so forth. So this can be a really critical one.

And then finally, value conflicts, and this is if you’re in an environment where you’re caught between conflicting values. You know serve the customer well, but actually what you’re supposed to do is sell them as many services as you can you know just to make more money and more sales. It can be where you’re in a situation of what they call you know moral injury, where you’re actually being asked to do something that is wrong, ethically wrong, or that you think is not the right thing to do, and this can be – when people are caught in these value conflicts, this can be the thing – if it doesn’t change, they’re going to quit and leave the job.

So the more mismatch that the people are experiencing in one or more of these six areas, the greater their risk of burnout over time. So let me put the six areas plus one other, in this case. This is the physicians again, going back in North America. They also wanted to answer questions about administration, so we added those, but you can see with the six areas, for people on the far right who scored as burned out, high negative on all three dimensions, everything was going south for them in the workplace. Everything was below average. Well, it was below the baseline for physicians. On the opposite side, the far left, you see for people who are saying they’re not burned out, they’re engaged, everything is looking good. It's better than average.

But look at the people in the middle. In particular, look at over-extended in the very middle, and you can see that in most cases everything is kind of okay, so-so. It’s not bad. It’s not great – except for workload. That’s the exhaustion-only group, and if you look at them, they have a huge issue with workload being very bad and a mismatch, but overall they do not look like they’re burned out. Very different pattern profile of their workplace. The one that shows a closer alignment is cynicism, and when you’re disengaged and you’re beginning to move in that direction, the ineffective – actually, it might take even less positive intervention to get them more engaged. They’re sort of there, but they’re often you know not getting much feedback or opportunities, etcetera.

So these different experiences of work life are matched up with different problems in the workplace. So let me give you a little example of what might happen to try and pivot from those six areas to make things better, and this was an organisation that I worked with a number of years ago, and there’s about 1000 people. This is not healthcare, however. This is all kinds of administrative services for a large organisation. This unit had about 1000 people. 87 percent of them answered, so this is the mean scores on the six areas at the beginning, and let me point out that the CEO was sure that the problem areas would be workload, because everybody complains about working too hard, or rewards, everybody doesn’t get enough pay.

It turned out that was not the problem area. For all of these people, fairness was one of the issues and values. He was shocked, could not believe that it was fairness, but what they decided to do is fix things, and they found a number of issues, but one of the ones that everybody really hated was something called a distinguished service award, which was hated – you know you get extra money for doing something special – because everybody thought it went to the wrong people. There wasn’t a fair process for who got that award. You had to be nominated by your supervisor, but if you had a supervisor who didn’t bother doing that kind of stuff, you wouldn’t get nominated. It would go to the – or it would go to the head of a team that did something really special, but none of the team members got any of the award, and so forth and so on in terms of fair procedures.

So they worked on it for a year, the whole organisation, and to try and come up with a better way of actually recognising and rewarding people, the CEO though, “Well, maybe we just have more money,” and they pointed out it wasn’t reward issue; it was fairness. That was the problem. They finally, during the year, came up with a better version, and they implemented it, and people were much happier with it, and a year later when we went back and assessed them, look what happened. If you look at fairness, they turned it around. Before it was a negative evaluation, now it was positive. They had really made a different. People were feeling like, “Yes, we’re doing the right thing now.” But also look at the ripple effect.

The effect of working together to change something that everybody really didn’t like and thought was highly unfair actually had positive benefits for all of the other six areas, so much so that this organisation, like others, now does an annual or a biannual what-could-we-fix-this-time. What is the pebble in the shoe, the chronic stressors that just irritate you, drag you down? What could we do to make it better? And what we have found is that working on these issues within these six areas, one or more of them, finding out where the problems are, pivot, look to how we can make a positive improvement, has other effects, builds optimism, hope. If we can fix this, we could fix something else.

So basically, for a healthy workplace, it’s useful I think to use the six areas and say, “What is the pivot that we’re looking for? How do we get a sustainable workload? How do we get recovery and balance, and you know good boundaries between work and non-work life? How do we build in appropriate levels of discretion and choice and autonomy so that you can innovate and do things better? How do we build in meaningful recognition and reward that people actually you know feel good about? How do we build a more supported work community?” One of the things people often say is, “I wish I had someone I could talk to confidentially, a safe place when I’m running into problems, when I have questions, when I need some advice,” and, “I’ll be there for other people, but I wish I had that.” That kind of mentorship, that kind of connection is huge.

How do we make things more fair? What are the things that people are thinking are you know rigged system against it? How do we build that sense of fairness, which is about respect and treating people well, in socially just ways? And how do we make the work more meaningful so that whatever it is that we’re doing and contributing overall is something that we’re proud of and feel good about and want to continue doing and even do better? So in a sense, these are kind of the goals that people in units or on their own or in larger organisation can sort of pivot to and say, “How do we make some steps in those directions?”

So what this means, the good news is it’s not one thing that you need to do about burnout. It turns out there’s at least six different areas where you can start on the path toward getting a better fit, a better match between people and the job, and these changes don’t have to be big, and they don’t have to be you know overwhelming to even contemplate. They’re often – because they are these things that people call the pebbles in your shoe, they’re small. They can be inexpensive. They can be customisable, and they can be done with teams or groups or units and are often more effective.

In many cases, if I want to make an improvement in my job, I have to work with other people, because if I leave early, let’s say, come early, leave early, I’m going to have a negative impact on other people, so we have to all kind of work together in a “we” rather than a “me” to make some of these changes that will be better. And if we get this kind of healthy job environment you know it’s going to benefit workers. It’s also going to benefit the workplace, and so all of that will be you know getting to a better tomorrow and a healthier tomorrow and a healthier workplace.

So a couple of points we’ve learned over the years, three Cs. One is collaborate. Get everybody involved. Get feedback. Get buy-in. Too often we have things that are done to the workers which they don’t appreciate. It doesn’t help, and a lot of money is spent on something that they think is not helpful at all, so we really need much more collaboration. Customising it: you can’t just take a best practice and just apply it without implementing it to fit the local culture, and I’ve seen things that, with best of intentions, failed because of not customising it. And commit: you have to keep working at it until you get some positive gains, so evaluating it and modifying until you get it right. A one-day workshop is not going to do it. It really takes time to undo some things, put in some newer things, practice them up so that they get to be regular process. So all of those are helpful as you make these changes for a better match between the job and the person.

So it’s much more about the chronic situational process. These improvements that I’m talking about, we have gotten data over the years that show that they help prevent burnout and build engagement, but it’s not enough just to cope with the stressors. You actually want to change the stressors in the workplace to prevent future problems. A lot of these are social improvements that require reciprocal relations. We have to work together on these things in whatever group or unit, etcetera, and those six areas, it’s a great tool. It helps you identify where the problems are, where the strong points already are, and then using those as, okay, how could we move along that dimension to get to a better place?

So I think a lot of the lessons we’ve learned from burnout are helpful in pointing out where we can make a difference. We’ve collected data over the years on how this can happen, and it’s something that all of us can do to help make our workplaces a better place for everybody to thrive rather than to get beaten down. Thank you.

Natalie Bekis:  Thank you, Christina. That was absolutely wonderful. We’ve got a lot of questions, so – I’ve got some myself, but anyway let’s go to the chat function first. So thanks, everyone, for posting your questions. The first question that’s come in is what has led you to research burnout? Why did you look at this issue?

Christina Maslach

Interesting question. I didn’t know anything about it. I stumbled on it completely by accident. It wasn’t well known. This was back in the 1970s, when I was just starting my academic career as a faculty member at UC Berkeley. I had been trained as a laboratory social psychologist. When I got there, my lab wasn’t ready yet, so I thought I’ll go out and interview people, because I was interested in emotions and emotional – how you deal with emotional challenges, and I thought I’ll interview people who face this in their work, and then I will use that as my hypotheses when I get into the new lab that I’m going to have.

Well, it turned out people would answer my questions, but they then said, “Can we - this is confidential, right?” “Yes.” “Okay. Can we talk about what’s going on in the job? I have some other things I want to share with you,” and after a while I began to see that I was getting a similar story from a lot of people in many different kind of places, and nobody really had a word for it at that point, but I finally shared some of what I was hearing at a dinner party.

I was sitting next to somebody who was a lawyer, and she said to me, “Oh, my gosh. That happens in legal services where I used to work, and we called it burnout.” So then I would, in my interviews, say, “Okay. Is it detached concern? Well, no. Is it dehumanisation and self-defence? No. No. No. Is it burnout? Yes. That’s it. That’s it.” And it was such a – you know to find out about this, people would cry. They would get angry as they described these things, and I kept thinking, “My God, this is a problem, and I should change my research focus,” and so I started off at that point.

Natalie Bekis

Fantastic. Thank you. The question is about how much does a person’s own resilience affect their likelihood that they will experience burnout?

Christina Maslach

Excellent question. It’s – because it’s essentially saying what is it that the person is bringing to the relationship with the workplace. Unfortunately, the challenge has been that people think if you’re just resilient or if you’re just strong or you’re just healthy, you won’t have to worry about anything, and we found that that is not true, that you can you know be doing the best you can to cope with this, but sometimes the stressors, those chronic stressors, are going to outweigh that, and you can’t change it and you can’t respond well, etcetera.

So I’m sure you’ve heard, or maybe you’ve heard this, the common phrases, “If you can’t take the heat, get out of the kitchen,” and basically it’s saying what’s wrong with you if you’re not strong enough, if you can’t take the – you know you’ve got to be – you know handle stress that way, and basically I think what the research is saying is you’ve got to look at the kitchen as well as the resilience. The resilience is helping you to cope with the job, which is what it is, and we’re raising the question – and I think that’s the silver lining, if I can say that, to the pandemic, is that it forced the workplaces to change, not always in a better way, but it raised the option, we could do this differently.

We don’t have to just adjust to – you know it is what it is. So you could rethink the kitchen and the kind of people who are running it or the temperature or the ventilation or – you know all of that kind of thing to make it a better environment. It’s not just about, “Hey, you. You’re just going to have to cope and cope and cope.” So coping is great, and I’m not knocking that, but the – what we’re finding is that the relationship between the people and the job is really critical, and you have to have as much focusing on how do we change what’s going on with those job conditions, those chronic stressors that are not well managed. That has to be part of the solution, not just everybody trying to lift themselves up.

Natalie Bekis

Yeah. Fantastic. That’s – I love that, getting out of the kitchen or changing the kitchen. Love it. This is a really broad question, but I think it’s quite interesting. Someone has asked: the definition of burnout here seems to have a lot of overlap with depression and anxiety, which we know frequently presents as co-morbidity. You have said burnout is not an illness, but I was wondering how much work has been done examining the relationship here. To what extent can burnout be explained by depression and/or anxiety? Are there increased risks of burnout for those people in our population?

Christina Maslach

Basically, what the research has been showing is, as I mentioned just briefly, it’s a – burnout can be one, not the only, step in the path towards depression. When you get people who have severe clinical depression and have anxiety or other kinds of things, burnout usually has been an earlier step, and it’s not the same, and the research that is – there have been people arguing that it’s just – they’re one and the same. The American Psychiatric Association says no, they don’t agree with that, but it can be a factor. I mean, if you’re dealing with these problems and it's not getting better and it’s leading to other problems in your life, sure, it can lead to other kinds of you know depression, anxiety, etcetera, but it’s – I think it’s fairly clear that they’re not the same, so it’s not that you’re depressed and then you’re burned out. It’s burned out, and it can lead – and then it can get cyclical you know if you get more depressed and you’re not doing as well, then that can you know enhance it.

Natalie Bekis

Yeah. Absolutely. Thank you. And the last question – we’ve only got a couple of minutes to go, but I think this is an interesting question. How do you rebuild the trust necessary to address the cynicism effect?

Christina Maslach

Yeah. Yeah. That is a great question and a challenging one, and it’s really one that cannot be done by coping individually. It really requires a group team you know effort, and one of my colleagues that I’ve done a lot of work with, Michael Leiter, who spent some time in Australia, actually, the last few years in Deakin University, has spent a good chunk of his work developing prostheses that can be implemented within a group or an office or a team that will build that kind of civility and trust and a better workplace culture.

He has one that he calls SCORE. The one he used to work on was called CREW, which is Civility, Respect and Engagement at Work, and it really was getting people working together to create a kind of better culture, shared culture that we have, going through practices of how to handle problems in a better way or a worse way and how to improve all of that. And it takes some time, and it takes some commitment, but those can definitely be done, and if you contact Michael Leiter, I’m sure he will be happy to share how this works. I think he even actually did a whole SCORE procedure with Unison Hospitals while he was in Australia and you know has a lot of evidence to show how it changed and created a better environment over that time period.

Natalie Bekis

Thank you so much, Christina. We are out of time, but I think we could all listen to you for the rest of the day. It is a really meaty topic. I think it’s a key challenge for workplaces, not only here in Australia but obviously worldwide, and so I can’t thank you enough for both your research, but for sharing your wonderful insights with us today, so thank you very much for your time.

Christina Maslach

Thank you very much for having me. I’m glad to be able to share it.

Sharon Parker

So I’m going to focus on actually changing the work that people have and introduce a model called the SMART Work Design model. If you can just go forward, I don't know how we’re going to do this a bit more quickly, because I use a lot of animations, so – and just go forward a couple there. I just want to very briefly mention that I’m from the Centre for Transformative Work Design. If you’re not familiar with us, we do research on all things work design, but we also have a strong focus on impact, and so this is where we’ve introduced the Thrive At Work model, which I won’t talk about today, but it is a model of mental health, and then today I’m going to talk about the SMART Work Design model, which is really part of our impact work.

So if you can go through – forward a couple. OK. And those things obviously – just if you just stop there. I want to talk about mental health, because – sorry, work design, and I guess my metaphor for thinking about it is a bit like an iceberg, and what often happens is we see – above  the iceberg we see the symptoms of poor work design, including low job performance, low innovation, and stress and burnout. But what we see happening, if you can just click forward a couple there, is that people focus on treating those symptoms rather than actually focusing on the root cause, which is the poor work design.

So I’m not saying there’s anything wrong with Employee Assistance Programs, for example, as an important support for mental health and wellbeing. It absolutely is, and it’s vital, but it’s also often – sometimes it’s treating the symptom rather than the cause, so if you could just move onto the next slide and the next one. Thank you. Sorry. I wouldn’t have done it this way if I’d known we were not going to be able to be in control of it.

So what is work design? Well, work design is – really, it’s about the content and the organising of the tasks, activities, relationships and responsibilities within a job or role, or a set of jobs or roles, and obviously that’s a sort of fairly academic definition, and it’s because of that really that we introduced the SMART Work Design model, because, yeah, that’s fairly abstract, and managers and leaders say, “What is that? I don’t understand.” So on the next slide you can see what’s happened historically is many, many things have been measured and assessed as part of work design, and you can see those things up the top there, task variety, skill use, job feedback, etcetera.

But there’s probably more than 30 aspects of work design that are routinely measured, and that is also hard for people to get their head around, because it’s like, “Well, which ones should we use, and are they all equally important,” and so on. So what we have done is what’s called a higher order factor analysis, which is where we sort of take all of these dimensions and then say, “Is there any way in which they sort of fit together,” and this is where the SMART Work Design comes from. So if you just click forward.

So the first part of the model is stimulating, and you can see there that this covers aspects like task variety, skill use, meaning, complexity, and it’s really are people doing work that they find interesting, engaging and that’s got variety? If you can go to M. M is for mastery, and here we’re really focusing on role clarity in particular, so do people know what it is that they’re doing? Do they have role clarity? Do they get feedback on how they’re doing, and doing a whole job can be helpful too. This is the sense in which people know where their work fits in to the bigger picture, and all of these aspects help people to feel that they know what they’re doing and how they’re doing it and therefore have that sense of mastery.

A, the next one, is for agency, and this is fundamentally about autonomy and control, and I guess we used to call it autonomy, but now with autonomous trucks and autonomous machines, we’ve had a few confusing conversations with people in industry where we’re talking about human autonomy and they’re talking about machine autonomy. So these days we refer to this as agency, and this is the fundamental importance of people being in control of their work lives. R, the next one, is for relational aspects of work, and these are all the aspects of work that meet people’s fundamental need for human connection, and people do have a fundamental need for connection, and so having social contact at work, connecting with the end user of the work, getting support, being part of a team, not being exposed to bullying, all these sorts of things are important aspects of relational.

And moving onto the final one. T is often the big one when it comes to burnout, and this is about having demands that are tolerable. So we all have work demands. That’s pretty much the definition of work. We have things we have to do, but those demands of work, be they emotional, cognitive, work hours, they need to be aspects of work that are tolerable, and all that together is the SMART Work Design model.

So if you can go forward to the next slide, what I’d like to do is just unpack that a little bit more. There’s actually a huge amount of research, more than 5000 articles – actually we did a review a couple of years ago – looking at work design and its impact on all these things here. I’m going to only talk today about burnout, but many of these aspects of work design are also important for motivation, creativity, performance, also for learning and growth in organisations, and this is part of the beauty of work design and the reason I love it as a topic is because when you create good work, well designed work, you know it’s good for the company usually, the organisation, and it’s good for the people within it.

The next slide. Thank you. And you can see there that reference. Yeah. So stimulating – I’m just going to unpack each one a little bit more. You can see here we did some sketching of work design to help convey the ideas, and this is some hospital supply workers, and you can see they are saying things like you know, “There’s never a dull moment. I like the variety. This job teaches me a lot,” and that’s what stimulating is all about. It’s about feeling that you’re doing something meaningful and varied, and if you just click one more. Thank you. And there’s a huge amount of impact of having variety in your work, and again I’m not going to talk about all of those outcomes that you can see listed there, but I do want to note a meta-analysis.

And a meta-analysis, for those not familiar, is when you take a large number of studies to – often 30 or 40 studies, so all together thousands and thousands of people, and you look at the trends across those studies, and so this meta-analysis showed that actually if you have a lack of variety and if you do a sort of boring job, ironically, that can cause burnout, and that might seem sort of surprising, because you might think well, you know, gosh, if it’s boring, there’s nothing to do, how on earth could that be stressful? But as those of you who have been in that situation know, most of us want to go to work and do well and achieve things, and actually if we’re just doing the same thing over and over again and it feels meaningless, and we’re doing that day in and day out in a chronic way, as Christina talked about before, you know, that is ultimately quite stressful.

If you can go to the next slide, please. So stimulating matters. Mastery is – as I mentioned before, it’s about making sure people know what it is that they’re doing and getting some feedback on that, and you can see there an aged care assistant, and as you would all know aged care is one area where burnout is rife, but this aged care assistant is talking about, look, you know finding out how you’re doing actually helps or getting emails to say thanks or stars or whatever, you feel appreciated, and if we go to the next slide, you can see that again there’s lots of research on why mastery really matters, and you can see there, for example, research on a lack of role clarity predicting depression.

But what you can see there again I’ve put down the bottom the relationship between a lack of clarity and a lack of feedback with burnout, and again you can see a couple of meta-analyses actually referred to there. So you can see that actually clarity is perhaps a bit stronger driver of burnout, and that makes sense, right? If you don’t know what it is you’re meant to be doing, that is a recipe for stress because you’re going to be praised on it you know people have expectations of you and so on, and if you’re not sure what it is you’re going to be doing you know that is quite a stressful situation.

If we can move onto A for agency, so again to remind you, agency is about autonomy and having control over your work, and this is particularly important, if you just go to the next slide, for burnout, because if you have autonomy in your work it means that you can manage the demands that occur, so you know to use a simple metaphor, if you’ve got a window – and in fact this is – I’ll use a real metaphor you know.

If you’ve got those electric heaters in your office, and it’s all controlled centrally, and you can’t influence the heat in your room you know it is really annoying, because half the time it’s too cold and half the time it’s too hot, and you can’t manage that demand, so you know those good old-fashioned things you know where you can actually turn the heater up or down in your own office you know is an example having control over your demands, and of course if the demands are you know how long you should work or how many hours you should put in, having control over those demands is really, really important, and again you can see lots of evidence that a lack of control and autonomy relate to burnout, so you can see down the bottom there those links with the dimensions that Christina talked about before.

So -.25 for emotional exhaustion, -3 for cynicism and -.39 for accomplishment, and for those not familiar with these figures which are sort of beta weights, that is a big number, so people who don’t have autonomy really don’t feel that strong sense of accomplishment in their work, but it’s actually so important for burnout – part of burnout but also important for other aspects.

If we can move to R, the next one. Again, relational aspects, super important because we need to have those connections with other people, and on the next slide you can see that again a lack of support or bullying in the workplace, these are big drivers also of burnout, and you know many times – we do a lot of work with people who have very, very stressful jobs you know paramedics and so on, and often for them it’s not necessarily the stress of dealing with a traumatic road incident. I’m not trying to dismiss that, but often it’s the fact that they’re not getting any support for those incidents, and they’re expected to get – you know deal with a very difficult incident and then get straight back out on the road and deal with another difficult incident, and then those – that sort of kitchen ultimately creates a really bad recipe for burnout.

And then if we can go to the next one. T is for tolerable, and this is really again – to repeat what I said earlier, it’s about recognising we all have demands in our work, be those emotional – and you can see there some surgeons on the left talking about the demands of dealing with, for example, when someone is terminally ill. It’s very emotionally demanding. Or someone there on the other side, a geneticist talking about – this is a geneticist who solves – tries to solve or diagnose rare diseases you know the biggest challenge is time pressure and those intellectual demands.

And this comes back to something I think Christina said earlier you know these can be very manageable, and when these are manageable, this is fine. It’s when these aspects become unmanageable, or in the language of this framework, intolerable, that we then have a problem. So if we can go to the next slide, we can see there I’ve done a little map there of the number of deaths linked to work-related suicide versus the number of deaths linked to shark attacks. In Australia, we talk a lot about shark attacks, but we talk much, much less about work-related suicide, and often it is about these intolerable demands.

And again there see the link between role conflict, which is when you’ve got sort of conflicting expectations, so you’ve got – you’re being pulled in different directions. Your boss wants one thing; your colleagues want something else, or you, on the one hand, need to do something to adhere to safety requirements, but on the other hand, you’re getting pressured to produce a lot. That’s classic role conflict sort of situation, and you can see that role conflict and role overload just simply having too much to do frequently predict burnout, and again look at the numbers there of those meta-analysis findings, .53, .49 for predicting emotional exhaustion, and quite high also for cynicism. So really strong evidence that those factors are important for burnout.

Next slide. One thing is – to bear in mind, and we talk a lot with people about this in industry, because there’s – sometimes the response is, “We can’t reduce the demands. It’s the way the job is.” And now, I think that a point that both Georgie and Christina made is we should challenge that assumption, so sometimes you think you can’t change your demands, but you actually can. So that’s the first thing to say. But sometimes you really can’t, so you know police officers face really demanding situations, paramedics face really demanding situations, and realistically some of those demands will not be able to be changed. But we can always change the resources, so we can build up the SMAR component, and the – and evidence suggests that if people have got those resources, then they’re better able to deal with the demands.

So for example, if you have got a lot of pressure in your work, but you’ve got the agency to take a break, go for a walk if you need it, go for a jog at lunchtime if you need it, if you’ve got the relational aspects, you work in an environment where people are kind to each other and support each other, if you know how you’re doing, you’re getting feedback, you’ve got the mastery, then you’re much more likely to be able to deal with those demands, and that makes them more tolerable. So that’s important takeaway for managers and human resource people there, that there are different ways of addressing demands to make them more tolerable.

Next slide. Just if you just quickly go through this one, yes, and again, what you can see here – and I won’t go into detail here – is many of you will be familiar with the language of psychosocial risks, and I just want to note that the SMART Work Design model maps onto those psychosocial risks, but we just prefer to talk about designing good work, smart work, is the frame that we approach this from. Next slide. Next slide.

Thank you. And I just want to show you also here – could show you many, many examples, but this is from a work-from-home study that we did, so during COVID we did a nine-wave longitudinal study tracking people’s SMART Work Design whilst they were at home and then linking it to their mental health and wellbeing, and again I’m not going to go into detail here, but what you can see in that red box is the correlations or the links between the aspects of the SMART model and then people’s burnout, and what you can see right down the bottom is you can see workload is a strong correlate.

Work-family conflict just makes sense during COVID particularly, work-home interference, and poor communication. So there are a lot of communication problems. This data is from fairly early in the pandemic, and that was quite stressful for people, but you can also see that those other aspects, the SMAR, also relate to burnout in the ways that you would expect. If you can go to the next slide. Thank you. And just flick forward a couple.

We have lots of resources, by the way, that are free on our website about creating flexible SMART work, so taking that research that we did on working from home during the pandemic and then turning it into guidance for managers, for individuals, and also for teams, so I just point that out, and if you can go to the next slide. So there’s two ways that work can be made smarter, and this is probably the most important thing, and it’s a great theme, I think, from the session today, which is that you can change the kitchen.

You can make work smarter, and one way you can do it is by identifying the things that influence work design, so for example, leader behaviours, the things that managers do influence smart work design. So during COVID, for example, we found that some people had micromanagers who were calling them up all the time, calling people up all the time expecting them to be at their desk all day, and that taking away of agency by micromanaging people by the leader you know, obviously, impaired people’s work design and actually contributed to their stress.

If you can just click the next point and again. You can also directly change the work – and I just wanted to give a couple of examples of this very quickly, conscious of the time – either through bottom-up job crafting or more top-down intervention. So on the next slide you will see an example of bottom-up job crafting, and what this means is that people can be trained and encouraged to actually change their job themselves, to get that better fit, and Christina mentioned in her talk the importance of fit, and so one way to get fit is for people to try and achieve that themselves, so if, for example, there’s someone who really likes lots of complex interesting things, you know, can they craft their job to be involved in more projects, for example?

And there’s actually a huge literature on this now and lots and lots of evidence that job crafting can work. Interestingly, not many studies looking at job crafting and burnout, I just have to note, but if you can just click forward, so just as an example, this is a study of some teachers where a control group got nothing and then an intervention group got some training, and usually this crafting training involves teaching people what crafting is, and then they do a little bit of a – they do an analysis of themselves and they do an analysis of the job, so they sort of work out what the fit is or the misfit, and then they sort of try to create some goals and some action plans for how they can try and get a better fit between themselves and their job, and then you know they do things like you know follow-ups to check that they’re actually doing it and so on.

And you can see that these sorts of interventions do work. They also do have some limitations, I should say, because one of the problems here is you are putting the emphasis onto the individual, so you’re, in a sense, saying, “Person you know the kitchen is too hot for you, so what can you do to cool the kitchen down?” And that can be a very successful strategy, but you can also see sometimes the kitchen is just too hot, and people should actually be changing the kitchen.

So if we can go to the next slide, we can also do interventions which are more top-down, so rather than putting the emphasis on the individual crafting their job, here the intervention would be led from the top, so led by managers, but in a very participative way, and again that comes back to the earlier theme that Christina mentioned around collaboration, so this is not about doing things to people but it’s about the change being driven from the top, the support and the commitment from the top, but in a highly participatory way.

And so just as an example there, 304 oncology care providers in the Netherlands had some highly participatory redesign, which means they come together and they figure out how they could redesign their work but with the support and endorsement of managers, and what you can see there actually is an interesting thing is you see that for the control group, the emotional exhaustion actually increased over time, and this was due to some things going on in the company, but for the experimental group, so the group that had the intervention, not a decrease in emotional exhaustion, but it sort of stayed the same, in contrast to the control group where you could see people got a lot more exhausted over time, and same result for the depersonalisation or the cynicism side of the burnout measure.

So you can see there – and this is just one example, there are many – of how you can redesign work in a more participative way but through the leadership of the organisation, and we do a lot of that sort of work ourselves, and I think – onto the final slide now. Thank you. Yeah. And just click forward, and I’m just going to summarise. So what I’ve really argued here is that one way to reduce burnout is to increase SMART work. You can use that little model to identify psychosocial risks. You can do it formally through surveys and those sorts of tools – that should say formally and informally. You can also just do it informally.

So with our group, for example, we just sometimes say, “Okay, let’s do S today. How is everybody’s work in terms of stimulating?” And then another week meeting we might do, “Hey, how’s everybody’s work in terms of mastering?” So you can also use it very informally. And the most important message of all is that it is possible to make work smarter, either by changing the things that cause or influence SMART work, like leadership or culture or technology, or by promoting and training workers in that bottom-up process of job crafting or by doing this more top-down participatory work redesign, and I gave that example at the end. And so that’s it from me. I realise I’ve left very little time for questions, but happy to take one if we can squeeze it in.

Natalie Bekis

Yeah. Thank you so much, Sharon. We are nearly out of time, but I think that we’ll do one question before we close, but for those in the chat, there is a heap of information that Sharon has on her websites. We have posted that for everyone, Sharon, so that they know where to go to find this. I guess you’ve given some really practical examples, but for leaders who this might be new to them – and I love starting practically on whatever element of the SMART you can start on – what’s your advice to leaders? Where should they focus first? And I think it’s probably fair to say that the SMART concept is not just going to help you address burnout but some of those other psychosocial hazards in the workplace, so I’m wondering if you can just pick that up a little bit too.

Sharon Parker

Yeah. Look, I think the starting point has to really be diagnosis, so what are the issues, and I think Christina made a great example before you know people sometimes have assumptions about what their – what the risks are, but they might not be correct, so a diagnosis is ideal, and you know preferably through something like a survey where people can be completely confidential and honest, but it doesn’t have to be a survey. You can have focus groups or you can have interviews or you can have a team discussion. I mean, obviously, it’s difficult for people if, for example, you’ve got a micromanaging boss and the boss is asking you know, “What are the psychosocial risks here,” it’s going to be challenging. So you need to try and find ways, but you have to start with diagnosis because you don’t want to try and change something unless it’s really one of the key issues. So use the model to try and understand where you’re at would be my first tip and what are the challenges in your workplace.

Natalie Bekis

Wonderful. Thank you so much, Sharon, and as I’ve said to the audience, there is a heap of research. I didn’t quite realise that there were 5000 articles already on good work design. It is something that Comcare is looking to do. My team are currently looking at this issue and we’ve been looking at your work, Sharon, on this very issue around how do we draw more attention to the importance of good work design.

With one minute to go, I do want to thank everybody who has joined us on the call today and thank you for taking the time out of your busy schedules to prioritise the importance of workplace mental health. I hope that you take something back to your workplaces that is equally as important, not only on workplace burnout but some of the practical things that you can do to care for yourself, whether that be in your role at work or your role in your family or community.

Page last reviewed: 03 December 2020
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Date printed 02 Dec 2021

https://www.comcare.gov.au/about/forms-publications/transcriptions/managing-and-preventing-burnout-in-the-workplace