For UC Berkeley psychology professor emerita Christina Maslach, PhD, creator of the widely used Maslach Burnout Inventory (MBI) psychological research tool, much of the current focus on the burnout epidemic in the health professions tends to point the finger at the individuals and what they need to do in order to become more resilient in their jobs. Instead, she says, we should look at the systems and job settings—the occupational phenomena that are creating widespread, chronic job stress.
“Our challenge is to think differently about burnout and to come up with better solutions,” she says. Even spending time away from the job for respite is only a temporary solution because the employee just comes back to the same job stressors that triggered the burnout. “Burnout is not a disease, not a medical condition. It’s an occupational response to chronic stressors. Typical solutions look at the effect but not the cause—stressors that could be handled differently and made less of a problem.”
Dr. Maslach’s plenary address at the Shiley Haynes Institute’s 2023 National Symposium for Academic Palliative Care Education and Research, scheduled for March 2 and 3 at the Long Beach, Calif., Hilton, will review six areas where a poor fit between the job and the person doing the job could be contributing to burnout. These six factors are reviewed in her latest book, “The Burnout Challenge: Managing People’s Relationships with Their Jobs,” coauthored with organizational psychologist Michael P. Leiter and published in November by Harvard University Press.
Six Burnout Factors
The systemic factors contributing to burnout identified by Dr. Maslach include:
- Work overload, including high demand but inadequate resources to meet that demand;
- Lack of control or sense of autonomy and discretion over one’s working conditions;
- Insufficient rewards—not just salary but positive feedback, social recognition, a pat on the back;
- Breakdown of community, including of relationships with colleagues, patients and supervisors;
- Lack of fairness, feeling that the rules and policies of the workplace are unjust; and
- Conflicts in values between the individual and the organization.
“We talk about all of these areas in our book, with illustrations of where people have made changes in the workplace,” Dr. Maslach explains. An example is a worksite where staff believed a distinguished service award was being presented to the wrong people—those who brown-nose their supervisor instead of those who truly deserve special recognition. “Once the company came up with a better selection process, the fairness issues went away,” Dr. Maslach says. “Then people said, ‘If we can fix that, we could fix other things as well,’” she relates.
“To be able to actually work together figuring out a better way builds hope and optimism in the workplace,” Dr. Maslach relates. The traditional workplace mantra holds that the job is what it is and the employee has to make the best of it. But that mantra was thoroughly negated by the COVID pandemic, when everyone’s job had to change.
“We learned that our jobs can be something else. They don’t have to be a certain way. We can do things differently. We didn’t see COVID coming. But when it came, we had to improvise in response. The world is always going to be changing. We should be thinking about how to redesign our jobs and find ways to do thing a little better.”
Is Palliative Care Especially Stressful?
What about the particular job stresses related to hospice and palliative care, given that so many of the clients are seriously or terminally ill and many will have bad outcomes? “I think it has to do with values and meaning in the work,” Dr. Maslach says.
“Why do I choose this work, realizing that it can be difficult work that most other people couldn’t do? What do I bring to it? What can I learn from others who have more experience coping with the losses and finding meaning in the work?” she poses. “How do we help patients and families move through these cycles of life in ways that don’t keep taking a piece of our heart until we have nothing left?”
There are ways of giving to patients while being able to replenish yourself and recover from the losses that are most stressful, she says. “Do you have other people to turn to when things get tougher than you thought they would be?” Palliative professionals often cite their co-workers, mentors, and “safe harbors” where they can go to talk without broadcasting that they have a problem.
“What are important supports for this kind of work? What does it mean to have helped someone with a life-threatening illness to have as good a life as they could have had for the time they were here, even if you couldn’t save them?” Learning to feel good about what the palliative care team was able to accomplish is hard to do by yourself, and could use some help, she said.
“We need to develop the social connections that can hold us together and comfort us and give us back more of that energy and commitment to make many lives better. It’s important for people in their training and on their job to figure out how to both receive and provide the kinds of strengths and supports that will make us feel good about the work we have done.”
For more information on the Institute’s 2023 Symposium, see the Symposium home page.