Ending the self-perpetuating cycle of burnout and bias
Burnout is recognized by the World Health Organization as an occupational phenomenon that presents as exhaustion and overwhelm, cynicism and depersonalization, and lack of effectiveness and reduced productivity.
Most often business leaders suggest self-care as a solution to burnout, which assumes that employees have resources they can dedicate to self-care, which may not be the case in all groups. This response, to blame the individual for not effectively managing their stress, not only suggests lack of awareness of the complex social determinants of stress including racial trauma, lack of equitable access to healthcare, and racism within the healthcare system itself. Not to mention the lack of diversity in mental health providers and the stigma in using such resources.
Stress management is important for our overall health, and many stress management techniques are evidence based and demonstrate return on investment for companies including exercise programs, meditation, or mental health services. Since stress can lead to maladaptive coping techniques such as drugs or alcohol, promoting healthy coping behaviors is important. Not only because it can reduce stress, but because it helps individuals gain a sense of control and mastery which can propagate across other behaviors at work and home.
However, the problem with businesses recommending health solutions, is that they may not be aware of the low population rates of the activities they are proposing as solutions. Less than 10% of the adult population meets exercise guidelines, and most exercise habits only last 6 months. The majority of users of even highly effective meditation apps, only stay engaged for a few months. Such solutions need evidence based behavioral support systems that are seldom provided by the companies such as dedicated time, space and peer group coaching.
More importantly, what does it say to employees when you ask them to take responsibility for their stress but your organization does not admit its role in contributing to the stress?
This focus on the individual as the problem and the solution ignores the workplace’s role in creating the chronic stress that leads to burnout shown by decades of research. Burnout can be caused by overwork, lack of autonomy, lack of reward, and lack of psychological safety. These are conditions within the workplace that are not solved by self care.
Not only is the workplace itself a potential cause of burnout, organizations will also become compelled by ESGs to recognize their responsibility to improve working conditions for all groups, including those who have poorer access to care outside of work.
If we acknowledge that a healthy diverse workforce is the most innovative and profitable, then it is important to reduce the biases that lead to burnout, interrupt the biases that also stem from burnout, and address the burnout that occurs in team leaders who are responsible for increasing diversity, equity, and inclusion.
Burnout increases bias. Many studies have shown that bias is often unconscious, formed overtime by our education and social status, and reinforced by stereotypes. Many interventions to reduce unconscious bias have been ineffective because single efforts at awareness raising do produce the ongoing skills needed to address very ingrained behaviors. If we consider bias as our default and that interrupting bias requires focused intentional effort, it is not surprising to learn that physicians who are burned out demonstrate increased racial bias towards their patients. And when their burnout decreases, their bias also reduces. Bias permeates so many workplace decisions and practices, and if the exhaustion and brain fog brought on by burnout limits our ability to recognize and consciously moderate such biases then these biases will be further perpetuated. Given the epidemic levels of burnout nationwide and the stark increases in burnout brought on by the chronic stress of the COVID-19 pandemic, we should be extremely concerned about its impact on bias.
Bias leads to burnout. Christina Maslach is a Professor of Psychology (Emerita) and a core researcher at the Healthy Workplaces Center at the University of California, Berkeley. Professor Maslach is the pioneer of research on the definition, predictors and measurement of job burnout who identified several workplace conditions that lead to burnout including overwork, lack of autonomy, lack of reward, injustice, value conflicts, and lack of psychological safety. A specific example of lack of autonomy, lack of reward, injustice, and value conflicts is epitomized in the maternal wall and the motherhood penalty. Mothers and particularly women of color are considered uncommitted and incompetent. They are expected to nurture and serve others, meaning they are judged if they do not say yes to unpaid office housework. Self-promotion and negotiating which may improve pay and promotion opportunities in men, are not considered stereotypical behaviors in women and research shows women are penalized, further perpetuating the inequalities.
Data shows that men are rewarded with a fatherhood bonus through increased pay and promotion opportunities because their status as a father implies they will need to be more committed to earning a salary to support their family. Whereas mothers are not even considered as eligible for increased pay and promotion - despite up to 80% being the main breadwinner in families, depending on race and ethnicity. The assumption made by managers is that they do not want to continue with their prior success and career growth trajectory because of their commitment to their family. The same commitment to family is seen as a threat to workplace commitment in mothers. Yet many working mothers, when asked, do want these opportunities to grow their career to support their families.
Current hiring and promotion practices that allow unstructured interviews and single manager decisions reinforce these systemic biases. Dr Iris Bohnet, the Albert Pratt Professor of Business and Government and the co-director of the Women and Public Policy Program at Harvard Kennedy School identified many of these biases in her book What Works Gender Equality by Design. Both male and female managers rate men as having more potential and competency even if resumes are identical or performance equal. And assessment tools such as self-appraisals disadvantage women even if managers make adjustments for reporting biases in men and women.
Psychologists Herbert Freudenberger and Gail North identified 12 stages of burnout. Stage 1 of this 12-stage process is the need to prove yourself. Studies show that even when women and men have equal performance histories, men’s potential is rated higher, resulting in their promotion and women’s need to re-prove themselves. Not only are lack of reward and injustice conditions for burnout identified by Maslach, but such biased lack of recognition leads to the first step in the burnout cycle; proving yourself. Which then commences the cycle of working harder, suppressing your needs, avoiding conflict and compromising on your values leading eventually to burnout.
Mothers also experience role strain. Mothers are expected to be the ideal worker available 24/7 and the ideal mother available 24/7. To work like they have no kids and to parent like they have no job. Such expectations are not placed on fathers in the same way. This type of role strain has been identified by sociology researchers to lead to burnout. Other financial stresses that parents in the US experience, are the costs of unpaid leave and the current high costs and unavailability of childcare services. These are daily ongoing stressors, caused by lack of government support for raising children, which are the type of chronic stress that contributes to parental burnout.
Psychological safety has been defined by Dr Amy Edmondson of the Harvard Business school as the belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes. Without the sense of empathy, belonging and inclusion, that comes with psychological safety, the daily microaggressions that women of color face (e.g. hair touching, name mistakes, competency surprise) are dismissed as personal issues not system bias. This daily exposure to racial incivilities contributes to increased chronic stress that leads to burnout. In the absence of psychological safety, employees can not speak about their burnout experience without fear of negative consequences, thus burnout goes unaddressed. Further, this inability to share burnout experiences, reinforces the perception that the individual is to blame, and without company wide assessments of burnout at the intersection of race and gender, then the systemic nature of the problem and its relationship to bias is overlooked.
Diversity, equity and inclusion (DEI) work leads to burnout. Often DEI work starts in designated DEI committees (i.e. not organization-wide) or in Employee Resource Groups which were originally formed so individuals of specific groups would have a safe place to discuss issues related to belonging to a specific group. However, many of these groups have evolved to be tasked with solving DEI problems in the workplace, due to their assumed interest and competency in this area. Members of these groups are not paid for their difficult roles in contributing to DEI solutions, leading to both overwork and lack of reward: conditions for burnout identified by Maslach.
Further, many already disadvantaged employees are expected to serve in this role, with the pressure of representing their race or gender, and without necessarily having the appropriate skills. This additional role, without pay or training, leads to role strain and role conflict, identified in sociology as causes of burnout. In some companies a DEI officer is employed, but without a supportive team or appropriate resources to change such widespread problems, the employee is left exhausted, disillusioned and ineffective - the very definition of burned out from the World Health Organization. Further, discussions resulting from addressing workplace bias can place already racially traumatized employees in positions where they are re-traumatized by the experience of explaining racism or being on the receiving end of on-going racists behaviors, despite efforts to raise awareness of these very behaviors. This ongoing stress results in emotional burnout.
If we thus acknowledge that burnout and bias stand at the intersection of workplace mental health what solutions can improve both?
In the same way unconscious bias training has been ineffective to improve DEI problems, vacation perks and mental health benefits will also only have short term, limited effects to address the bias that causes burnout. Burnout is chronic stress and long-term systemic solutions are needed.
Solutions to bias conditions that will also reduce burnout include:
-Bias interruption strategies that are practiced and reinforced
-Automatic achievement logs instead of self-appraisals
-Structured promotion processes using objective criteria
-Transparent pay bands and pay equity reviews
-Redistribution of office housework
-Paid leave and subsidized childcare
-Investments in ERGs and DEI teams
While promotion bias could be mitigated with automatic reviews, objective criteria, structured interviews, and diverse team decisions, such systems would only be adopted and faithfully implemented if the institutional commitment was clearly demonstrated. Systemic solutions require objective policies and procedures that are adhered to, institutional investment, and reinforcing rewards for quality improvement processes within the system. In this way, if well-being were a key performance indicator, reported to the board of directors, and measured as a criterion of success and profitability, then the most effective solutions would be prioritized and invested in at all levels of the organization. The organization would monitor progress towards this goal, align its values with this goal, prioritize those in most need of support, and reward leaders who supported this goal. If well-being were a key performance indicator, then the bias that causes burnout would be systematically assessed and addressed.
So the next time a leader suggests self-care as a simplistic solution to the complex systemic problem of burnout, remind them that they are perpetuating the bias that leads to burnout and furthering the burnout that leads to bias. Instead, challenge them to break this bias-burnout cycle with solutions that solve both issues.
