Preventing and Addressing Staff Burnout
Looking beyond the usual suspects
This blog about preventing and addressing staff burnout was written by Zach Walston, PT, DPT, OCS, National Director of Quality and Research at PT Solutions Physical Therapy.
This won’t be another article about the prevalence of burnout among clinicians.
We already know burnout is pervasive within healthcare. Additionally, the content written about burnout is robust. Google the phrase ‘burnout’ and you will receive 89,700,000 results.
Refine the search to ‘physician burnout’ and you still obtain 11,300,000 hits. There’s no shortage of content addressing burnout.
But does this apply to physical therapy professionals, too? It does.
So, what new information can we add to the mix?
In this article, we’ll discuss addressing cognitive frameworks. These are employed by individuals. They contribute to the development and maintenance of burnout. Our mental complexity and cognitive fallacies can (and do) influence our susceptibility to burnout.
You often hear of or read about the need to build resilience. This is certainly a strategy to utilize. However, it falls short without addressing foundational cognitive frameworks first.
Focusing on these factors in isolation perpetuates the notion that people lack mental fortitude. Following this mindset, we either need to ease up on work demands or build mental toughness. These messages can be shame-inducing and exacerbate the issue, giving the impression that it’s “either or,” but never both.
To be clear, many of the approaches used have merit. An excessive workload is sometimes an issue. This is especially true for therapists that have had to adapt to changes during the COVID-19 pandemic. Developing resilience – not simply telling someone to buck up – can reduce burnout risk. These, however, are not the only options.
Building resilience through lifestyle change in three specific areas also helps a great deal. They are:
- Dietary habits
- Sleep hygiene
- Stress management
Focusing on these three factors often allows us to better withstand seasons of challenge (such as the current pandemic). But these strategies alone fail to address many of the root causes. Our mental models and thoughts about work can dramatically influence our susceptibility to burnout.
To begin to have an understanding of these cognitive influencers, we need a foundation focused on what burnout is.
What is Burnout?
According to the definition from a report by Maslach and Jackson in 1981, burnout is characterized by emotional exhaustion, cynicism, and ineffectiveness in the workplace, and by chronic negative responses to stressful workplace conditions.
Emotional exhaustion is the depletion of emotional resources and feelings of being overextended by work. This is not only induced by working excessive hours. People become overextended when they put more into a job than they receive in return. Some people receive immense fulfillment and are energized working 16 hours a day, while others are emotionally drained by part-time roles.
The World Health Organization identified consistent evidence that “high job demands, low control, and effort-reward imbalance are risk factors for mental and physical health problems.” It’s important to also consider factors outside of work that predispose the development of burnout. These include financial stress (student debt), family life, and current events (COVID, social injustice, natural disasters, etc.).
People are all different.
It’s impossible to attribute an anecdotal experience of one person to the masses. Also, many careers possess seasonality. Some people may be able to grind during a residency program or when gunning for a promotion, but then need opportunities to throttle down later, perhaps when starting a family.
In the short term, throttling down may be accomplished through a vacation or letting a couple of projects go. For medium or long-term solutions, it may mean taking a lateral move to a new department. It can also mean stepping down from one role and current responsibilities.
If workload is not managed – recognizing that the term “workload” is relative – cynical attitudes towards work may develop.
This results in mental distancing and eventual reduced personal efficacy. This negative evaluation of one’s own work leads to feelings of insufficiency and poor work-related self-esteem. It is difficult to contain cynical attitudes and a reduction in personal efficacy. These emotions can easily spread between colleagues as people relate their personal struggles to those around them.
Burnout’s Effects on Everyday Life
Staff burnout stifles healthy professional growth and impairs personal and social functioning. It also overwhelms cognitive skills and the neuroendocrine systems. It eventually causes distinctive changes in the anatomy and functioning of the brain. This is dangerous for everyone, but especially those in the healthcare field – like physical therapists.
These changes lead to the following:
- Reduced efficiency and energy throughout the day
- Lowered levels of motivation in all activities
- Increased errors with work
- Headaches, muscle tension, GI problems
- Irritability, increased frustration
- High levels of stress and anxiety
- Suspiciousness and cynicism
- Trouble sleeping
- Feelings trapped, having a lack of control
- Using alcohol or other substances to cope
- Feeling worried about work while not at work
- Loss of interest (apathy) in events, activities and situations that used to make people happy
Knowing these signs is imperative, regardless of your position.
You need to recognize when you are approaching burnout and intervene at stages when changes are easier to initiate and complete. People need to be aware of the signs, as recognizing them in others is far easier than in themselves.
Recognizing signs doesn’t fall exclusively on the manager. Instead, recognizing and bringing awareness to potential burnout falls on everyone.
In healthcare especially, burnout may impair performance. This ultimately hurts the patients. People need to be able to help each other out and not hope a manager recognizes any and all potential issues. Emotions and bias heavily influence people. This is why sometimes it is easier to recognize signs in others than ourselves.
Having laid the foundation for what burnout is, it’s time to look at the influence our cognitive models have on experiencing and addressing burnout.
How Mental Complexity Affects Burnout Susceptibility
Many leaders understand the concept of emotional intelligence. This is our capacity to be aware of, control, and express emotions. Intelligence and building technical knowledge are not considered the sole standards for success.
It is now commonplace for leaders to undergo training and read books on developing emotional intelligence over time. One area of psychological development that does not receive this same level of attention is mental complexity.
Mental complexity determines how we perceive the outside world and make subsequent decisions in response.
The variety of response options and their effectiveness are influenced by the expansiveness of our perspectives, concepts, and vocabularies. As mental complexity grows, our ability to understand the outside world and control our response to it grows along with it.
Differences in mental complexity among two people often lead to two different responses to the same rigors and circumstances. Mental complexity alters our susceptibility to burnout. This is helpful over time, even in cases where staff burnout would otherwise be severe.
Mental complexity is divided into three categories. They represent a progression in complexity.
The socialized mind
- Shaped by the definitions and expectations of our surrounding environment
- Aligns with and is loyal to perceived identity
- Reliant on others to guide decision-making
The self-authoring mind
- Able to take a step back, take an outside perspective, to evaluate the situation, and make choices
- Able to take stands, set limits, and create boundaries that align with a personal belief system
- Seeks new information and perspective, but is resistant to information not personally sought
The self-transforming mind
- Can step back and reflect on the entire situation, including a personal belief system or code of conduct
- Seeks all possible perspectives and both values and is wary of any particular stance or belief, regardless of the source
- Can maintain multiple views on a particular issue and does not project one over the other
As you read through those categories, where do you fall? What about your colleagues?
Mental complexity develops over time. It does not follow the same trajectory as emotional intelligence. Experience plays a role. This is not to say all senior-level employees possess self-transforming minds and are immune to logical fallacies and burnout. However, experience does provide additional perspectives and opportunities to learn from past actions.
Most people fall within the first two categories. It’s a logical conjecture that a high proportion of the early career professionals who experience burnout possess a socialized mind.
These individuals depend more on their environment and their personal identity. Do you see how the mantra of “suck it up” or “build resilience” won’t work? It fails to address the issues of the environment. It also perpetuates the idea that the employee is a failure and simply not trying hard enough.
To address burnout, we must identify the work environment and understand how employees perceive themselves in that environment.
Our mental complexity also sometimes influences our susceptibility to logical fallacies. Everyone experiences bias and uses heuristics – mental shortcuts – to make decisions. The issue lies in the inability to recognize when those biases lead us astray and worsen the issue at hand.
Breaking Down the Root Causes of Burnout
Mentioned earlier, an abundance of articles have been written on the signs of burnout and surface-level solutions. However, more concern and attention needs to be focused on the root causes and why two employees may respond differently to a similar set of circumstances.
Common examples of methods that have been implemented include:
- Cutting hours
- Building in mandatory breaks
- Increasing pay
- Adopting a monthly one-on-one meeting model
- Building an office gym
These can certainly help, but this is a shotgun approach. It will help a few while missing others, and the degree of help will vary greatly depending on the underlying level of burnout. Another reason these solutions are incomplete?
They are external approaches. They fail to address the individual and the challenges they may be working through. For example, the gym may address a symptom but not a cause of the burnout. Increasing pay is a great reward for hard work, but it won’t reduce overall stress.
What follows is a list of logical fallacies that often contribute to burnout. This list also includes actionable items to address each:
Perfectionism is the refusal to accept any result other than “perfection.”
Perfectionism hampers achievement and is correlated with depression, anxiety, addiction, and life paralysis or missed opportunities.
- Develop clear goals and expectations for individuals and teams together.
- Gather input from everyone.
- Recognize warning signs and develop strategies for team members to easily discuss potential issues.
Polarized thinking is also known as ‘black and white thinking.” It is an irrational mindset that leads to unrealistic expectation.
Since there are no gray areas, people often feel frustrated, bitter, and disappointed if an expectation is not met. Either the job expectations or definition of work-life balance met or did not meet expectations.
- One-on-one conversations and having the individual work through the situation.
- Critically assessing all variables and degrees of factors influencing the issue(s) at hand.
- Having the individual identify and verbalize gray areas. Do not tell them where to focus.
Dunning-Kruger effect: It is common for early career professionals with little experience to overestimate their abilities.
Burnout risk spikes when the individual first understands their lack of ability. It is common to see a complete reversal in confidence and self-doubt becomes pronounced
- Consistent mentorship and empathy.
- Emphasize the expected learning trajectory and share the experiences of others.
- Recognize when someone is moving from the peak of “mount stupid” to the valley of despair.
- Provide resources for further development.
Anchoring happens when an individual depends too heavily on an initial piece of information offered.
For example, expectations set at school may create significant disappointment if they are not met during the early stages of a career (e.g. salary, caseload, best treatment approaches). It’s perfectly normal to set expectations, but being willing to alter them is necessary, too.
- Discuss and reinforce expectations consistently.
- Identify potential anchors early and have conversations to reconceptualize why those anchors may be incorrect.
Herd Behavior is the tendency for individuals to mimic the actions (rational or irrational) of a larger group.
Individually, however, most people wouldn’t necessarily make the same choice. Burnout can grow like wildfire and employees often feed off one another
- Addressing signs of burnout immediately before it spreads.
- Do not assume or limit potential or actual issues to a single person.
Sunk-cost fallacy is continuing a behavior or endeavor as a result of previously invested resources (e.g. time, money, effort).
For example, staying in a poor work environment due to investment towards a promotion or built up incentive (e.g. PTO bank), or clinging to outdated treatment methodology and continuing to achieve poor outcomes.
- Continuing to work hard, or even showing up for work, does not mean burnout is not present.
- Do not turn a blind eye to burnout risk in high performers.
When to address resilience for optimal understanding of staff burnout
There are two primary angles to address burnout: the work environment and personal resilience. In many cases, the main focus is on the work environment. Why? Resilience is often used as a cop-out.
Everyone has a breaking point, and no amount of resilience can withstand a toxic work environment.
Provided the environment is addressed, building resilience may help individuals weather the occasional unavoidable rough patches (e.g. COVID-19). Resilience is built-up by both the employee and the employer.
On the employer side, recognize the employee’s need for cognition. The tendency to engage in and enjoy cognitive endeavors can protect against burnout. Bear in mind, the challenge often changes depending on other variables and the seasonality of life. A physician can sometimes withstand, even thrive, with a certain caseload one month. However, they then start to drown the next because of life events.
Employees develop resilience through self-care. Engagement in behaviors that maintain and promote physical and emotional well-being help protect against burnout. These areas include sleep, nutrition, physical activity, social engagements, and rest. Employers can easily facilitate each of these areas as well with careful focus and extra attention.
Burnout is a complex phenomenon. To effectively address the potential drivers of burnout, you must identify the individual causes.
Cookie-cutter strategies do not work.
Making changes takes time. Burnout does not develop overnight and it cannot be eliminated with a couple of action items in a single afternoon. By identifying the influence all parties have and the mental models that influence both risk and resilience, employees and employers can work together to address burnout.
For more information on utilizing a network of physical therapy practice owners like yourself, look no further than the BetterPT networks of clinics. Not a one size fits all scenario, joining this network connects you with other like-minded practice owners, locations, and opportunities for growth.
Not only is this network great for staff morale and avoiding burnout, it’s also ideal for your patients, too. Giving them access to the BetterPT clinic location tool allows them to find your clinic and schedule both in-person and telehealth appointments online, increasing patient access and keeping them in control of their physical therapy plan.
Addressing staff burnout takes time, energy and effort – why not do whatever it takes to get and stay ahead of the feelings of being overwhelmed?
Zach Walston is the National Director of Quality and Research for PT Solutions Physical Therapy. Zach is the host of the Clinical Gap Podcast and his blog is focused on addressing healthcare misinformation. His goal is to get inside the mind of clinicians and figure out why they act and think the way they do. Zach believes that understanding this early gives them the best possible chance to grow and thrive within the field. He received his Doctor of Physical Therapy degree from Emory University, and has been published in numerous medical journals.