What is Burnout?

Introduction

The term ‘burnout’ has become ubiquitous within the common vernacular. Yet what do we actually mean when we say we feel burnt-out?

There are approximately 140 definitions for burnout in approximately 15 000 peer-reviewed papers^​1,2​ with little consensus for the criteria for symptoms and characteristics of burnout^​3​ . Commonalities amongst definitions are an acknowledgement that burnout is an occupational experience, it involves psychological and physical exhaustion, burnout has a negative impact on individuals, and it is multidimensional. If we are all referring to burnout with no common understanding, then our desire to create interventions to prevent it becomes incredibly difficult.

For burnout to exist it must extend beyond exhaustion.

The Podcast

How burnout is measured

The gold standard for measuring burnout is the Maslach Burnout Inventory (MBI). It is a 22-item survey that measures three dimensions emotional exhaustion, depersonalisation, and personal accomplishment.   The three dimensions comprising burnout are regarded as continuous rather than linear, and to date, the literature does not support evidence of phases or stages of burnout, or the existence of a ‘typical’ burnout process.

Emotional exhaustion (EE)

This is strongly correlated with stress and refers to psychological depletion, overwhelming exhaustion, loss of energy and the emotional fatigue experienced due to employment experiences^​4,5​ EE is a core construct of burnout, though on its own, it is exhaustion, not burnout.

Depersonalisation (DP)

This represents the interpersonal features of burnout (National Academies).  DP has been described as a crisis of meaning, and a loss of ability to live by personal values (National Academies). DP can present as cynicism, irritability, inappropriate attitudes, and a lack of interest in clinical work and compassionate care towards patients.

Personal Accomplishment (PA)

Refers to an individual having a sense of efficacy or competence with their work. Low PA is characterised by an individual’s sense of inefficacy, incompetence and concerns they are not achieving or are non-productive in their role (National Academies, Maslach & Leiter, 2016).

In 2016 Maslach and Leiter, in recognition that the MBI was being modified and misused, extended the measurement of burnout to include workplace profiles^​4,6​ . The MBI was originally designed for discovery of the systemic issues in a n organisation so that organisations could engage strategies and planning to create change so their employees could thrive^​6​ . The new workplace profiles generate five profiles of people’s work experience:

• Burnout: exhaustion, cynicism and professional efficacy
• Overextended: strong negative skill on exhaustion only
• Ineffective: strong negative score on  professional efficacy only
• Disengaged: strong negative score on depersonalisation or cynicism only
• Engaged: strong positive scores on exhaustion, depersonalisation and professional efficacy

In the Harvard Business Review 2021 Maslach stated that burnout profiles allowed for targeted systemic interventions and that the MBI was currently being used in a way that was unethical and inaccurate^​6​. Maslach also called for burnout to be explored with qualitative research to better understand issues for employees (Maslach, 2021)

6 things that affect how employees experience burnout:

1. Excessive workload
2. Lack of control and autonomy
3. Having recognition and rewards
4. Social support
5. Fairness and transparency at work
6. Shared values

What Burnout is (and what it isn’t)