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 (Hewitt et al, 2020, Hillert et al, 2020) with little consensus for the criteria for symptoms and characteristics of burnout (Bianchi et al, 2019). 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 become incredibly difficult.
For burnout to exist it must extend beyond exhaustion.
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) is strongly correlated with stress and refers to psychological depletion, overwhelming exhaustion, loss of energy and the emotional fatigue experienced due to employment experiences (Maslach & Leiter, 2016, Koutsimami et al, 2019). EE is a core construct of burnout, though on its own it is exhaustion, not burnout.
Depersonalisation (DP) 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 (Maslach, 2021, Maslach & Leiter, 2016). 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 (Maslach, 2021). 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 HBR 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 (Maslach, 2021). 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:
- Excessive workload
- Lack of control and autonomy
- Having recognition and rewards
- Social support
- Fairness and transparency at work
- Shared values
What Burnout is (and what it isn’t)
|What Burnout is||What Burnout isn’t|
|Being overworked due to a deficit of organisational resources||A lack of personal resources|
|Poor rostering schedules||Due to an absence of mindfulness|
|Rosters that are not distributed early enough to allow staff to organise their personal lives||A lack of resilience or hardiness|
|Not enough recovery days in between shifts||A lack of skills|
|No opportunity for professional development and growth||Anything that upsets you at work. Sadness, distress, anger, and compassion fatigue are not burnout. If these things persist due to systematic issues they may contribute to burnout over time|
|A lack of transparency for job promotion and career opportunities|
|Problems with leadership|
|When an organisation talks about values and missions and acts in the complete opposite way|
- Hewitt DB, Ellis RJ, Hu Y-Y, Cheung EO, Moskowitz JT, Agarwal G, et al. Evaluating the Association of Multiple Burnout Definitions and Thresholds With Prevalence and Outcomes. JAMA Surg. 2020;155(11):1043-9.
- Hillert A, Albrecht A, Voderholzer U. The Burnout Phenomenon: A Resume After More Than 15,000 Scientific Publications. Frontiers in psychiatry. 2020;11:519237-.
- National Academies of Sciences E, Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Wellbeing. Washington DC: National Academies Press; 2019. P. 334.
- Maslach C, Leiter MP. Understanding the burnout experience: recent research and itsimplications for psychiatry. World Psychiatry. 2016;15(2):103-11.
- Koutsimani P, Montgomery A, Georganta K. The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Front Psychol. 2019;10.
- Bianchi R, Schonfeld IS, Laurent E. Burnout: Moving Beyond the Status Quo. International journal of stress management. 2019;26(1):36-45.
- Maslach C, Leiter MP. How to Measure Burnout Accurately and Ethically. Harvard Business Review. 2021(March ):7.