Why burnout solutions fall short – a new multi-level approach from left field
Paradigm shifts often come when concepts from one field of study are transferred to another. Most burnout solutions have come from business schools and focus on managing burnout. A common approach is to reduce the stressors and increase the resources. And this can be an effective method, lowering your expectations to reduce stress, delegating work, paying for services or asking for help.
Another common solution for burnout is self-care. 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.
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? It’s like saying that the pay gap is because women don’t know how to negotiate and providing negotiation training as the solution. Research has shown women are penalized when they negotiate, and the pay gap is caused by systemic bias, so most women do not welcome this ‘fix the women’ approach.
And what if an employee does take an extended break, regains control of their stress, and returns to work? The stress will hit them like a truck. And they will more clearly see the source of their stress is the workplace. Then they will seek employment elsewhere. The health benefits and perks, designed to retain employees, fail.
Workplace burnout was defined as an occupational phenomenon by the World Health Organization in 2019 and the conditions that lead to it are described by Dr Christine Maslach including: overwork, lack of autonomy, lack of reward, injustice and value conflicts. The WHO is a public health agency, and burnout is reaching epidemic levels. So how would a public health expert approach this problem? And can this expertise from ‘left’ field lead to a paradigm shift in burnout solutions?
In public health, complex widespread health problems such as obesity are now addressed with multi-levels solutions. While we still encourage exercise and healthy eating, we do not blame the individual for their inability to maintain this habit alone. We recognize the role the family plays in supporting health behaviors, we understand that communities, schools and workplaces can be sources of support through fresh vegetables and recreation spaces, and we strive for healthcare, housing and transportation policies that make these health resources available to all.
Another reason we, in public health, focus on change at different levels beyond the individual, is because organizational and social change is more widespread and long lasting. Creation of healthy policies and environments prevents disease in large population groups, meaning expensive individual treatments are avoided. In addition, when policies are implemented at scale they provide health resources to groups who do not have individual advantages and therefore reduce health disparities.
Unfortunately for burnout, workplaces are stuck in the individual diet and exercise mode, or self care, which is an insufficient response. This more comprehensive public health approach to widespread health problems is based on the Social Ecological Model of Behavior Change. It posits that there are influences on our health at the individual, interpersonal (family, friends), institutional (education, healthcare, workplaces) and societal (legislation, social norms, economic forces) levels.
So how could we apply such a model to burnout? Let’s take working mothers as an example group who are experiencing high levels of burnout, exacerbated by the COVID 19 pandemic.
1) At the individual level, they may be a people pleaser and perfectionist, personality traits that are related to burnout.
2) At the interpersonal level, they may not have a partner to share the parenting load.
3) At the institutional level the maternal wall and the motherhood penalty are conditions for burnout exemplifying two conditions highlight by Dr Maslach: lack of reward and injustice.
4) At the societal level expectations for mothers to be martyrs to motherhood create social expectations to care and serve others. In addition, lack of affordable childcare and lack of paid parental leave contribute to the stressors that effect our ability to perform well at work.
Given these multi-layered influences on burnout, is there any indication that self-care would be the appropriate solution? In contrast, two international public health review papers and two US national academy of medicine guidelines recommend multi-level solutions as the most effective approach to prevent burnout. We can also draw upon the social design work of Prof Iris Bohnet in her book What Works: Equality by Design. In this way, multiple fields converge to solve a complex problem and intersect to create the type of paradigm shift we need to produce social change at scale.
Using the same example of the working mom burnout, we can apply a multi-level approach to the solutions.
1) At the individual and interpersonal level a work-subsidized coach could a) help set reasonable expectations around mothering, b) provide communication tools to leverage support from a spouse or colleague, and b) support boundary formation as an accountability partner.
2) At the institutional level companies could provide subsidized childcare, paid parental leave, objective and structured hiring and promotion systems adhered to by diverse teams, and transparent pay bands.
3) At the societal level, advertising would not portray working moms as superheros, Dads would not be viewed as babysitters, and governments would provide child tax credits and affordable childcare.
Importantly companies can play a role at each level, subsidizing coaching, creating psychological safe workplaces, and advocating for paid leave for all. In the same way multi-level approaches to obesity more effectively address health disparities, multi-level approaches to workplace burnout will also improve diversity.
The business case for a healthy and diverse work force are clear in terms of profitability, innovation, talent retention, absenteeism and reduced healthcare costs. The question remains, how much is being wasted on ineffective burnout solutions?
They key to unlocking these multi-level solutions from the field of public health actually comes back to a business concept. The key performance indicator. 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, and reward leaders who supported this goal.
This is what the future of well-being at work could be.
