Understanding and Preventing Employee Burnout

On occasion, the medical practice manager may observe an employee who is becoming increasingly more irritable and who is increasingly often late for or absent from work. The employee’s enthusiasm may have waned, too, and his or her productivity may have dropped. Whereas the employee was once a smiling and upbeat member of the medical practice team, the manager may notice that he or she now rarely cracks a smile, and most of the time seems cloaked in sadness. If you observe changes such as these in a member of your medical practice team, you will be concerned every time you see or think about that employee, and your gut instinct will tell you that something is terribly wrong. And, of course, you will be right. People do not change in these dramatic ways without reason and without cause for concern.

The “something wrong” with such an employee may be a number of things, but among these, it is possible that the employee is experiencing burnout. In fact, that’s a pretty good first guess. That’s because employee burnout is on the rise today, according to many sources. For example, PubMed Health(1) says that employee burnout is receiving “constant media attention” today, because more and more employees are missing work due to burnout. The Wall Street Journal(2) reports that burnout currently is so prevalent that an increasing number of employers have farmed out their employees’ well-being to employee assistance programs, where stress and anxiety are cited in a whopping 70% of incoming calls. And as Rampton(3) puts it succinctly, “There’s an epidemic in the American workforce. And, no, it’s not unemployment. It’s employee burnout.”

Managers can learn and implement a number of techniques that prevent employee burnout.

What can you do to help? First, it’s important that medical practice managers understand what burnout is and isn’t, and how they can recognize when an employee is possibly experiencing job burnout. As well, managers can learn and implement a number of techniques that prevent employee burnout. This article provides a good overview of the topic and a list of practical preventative strategies.

What is Employee Burnout?

We all have stressful, difficult, or hectic days at work. However, an employee who experiences an occasional bad day is unlikely to become burned out. As Scott(4) explains, burnout is a reaction to prolonged or chronic job stress. Therefore, it takes time and consistent, repeated stress for an employee to become burned out.

Employee burnout occurs when employees are physically, emotionally, and/or mentally exhausted. A review of the references consulted for this article suggests that burnout has three primary hallmarks:

• Exhaustion. Employees affected by burnout feel drained and emotionally exhausted, unable to cope, tired, and down. They have low energy.

• Cynicism/less identification with the job. Burned out employees often feel alienation from work-related activities. Sometimes, they experience a feeling of numbness about their work. They may also dread going to work and find that doing so becomes harder and harder each day.

• Feelings of reduced professional ability and capacity. Employees experiencing burnout begin to doubt their capabilities or the value of what they are doing or contributing.

According to Scott, the term burnout is relatively new, first coined in 1974 by Herbert Freudenberger in his book, Burnout: The High Cost of High Achievement. Freudenberger originally defined burnout as “the extinction of motivation or incentive, especially where one’s devotion to a cause or relationship fails to produce the desired results,” Scott says. Today, most people are familiar with the term. However, and surprisingly, there is no single clear clinical or scholarly definition of what burnout really is. Although burnout is not a recognized clinical psychiatric or psychological disorder, Scott says, there are some similar features between burnout and diagnosable conditions such as depression, anxiety disorders, or mood disorders. They share many of the same symptoms.

Ten Common Symptoms of Employee Burnout

PubMed Health warns that there are no well-studied methods to use to determine with certainty whether an employee is experiencing burnout. In fact, burnout is considered to have a wide range of symptoms. However, there are a number of questions that can be used for self-assessment, and certain burnout symptoms are considered to be typical.

Among such questions and symptoms, the Mayo Clinic(5) suggests that an employee who answers yes to the following 10 questions may be experiencing job burnout:

1. Have you become cynical or critical at work?

2. Do you feel that you must drag yourself to work?

3. Do you have trouble getting started on your work once you arrive in the office?

4. Have you become irritable or impatient with coworkers and/or patients?

5. Do you lack the energy to be consistently productive?

6. Do you lack satisfaction from your achievements?

7. Do you feel disillusioned about your job?

8. Are you using food, drugs, or alcohol to feel better, or simply not to feel?

9. Have your sleep habits or appetite changed?

10. Are you troubled by unexplained headaches, backaches, or other physical complaints?

Affirmative answers to these questions may indicate that the employee has a health issue, such as depression or a thyroid disorder, that requires medical or mental health attention, the Mayo Clinic warns. And, in some cases, an employee’s stress may not be work-related. However, there also is a chance that an employee who answers yes to even one of these questions is experiencing job burnout, the Mayo Clinic suggests.

Guilt is a surprising symptom of burnout.

There are a number of other symptoms of burnout to consider in addition to these 10 questions. For example, according to Scott, withdrawing from interpersonal relationships and increasing pessimism may suggest burnout. Carter(6) cites an uptick in anger, loss of enjoyment, feelings of hopelessness, and forgetfulness as common burnout symptoms. Right Diagnosis(7) suggests that gastrointestinal disorders may be linked to employee burnout. And Stillman(8) suggests a surprising symptom of burnout: guilt. If you notice changes such as these in an employee, something is most definitely wrong, and it may well be job burnout.

What Causes Employee Burnout?

We all have different tolerances for stress and different support systems outside of work. Our ability to cope with stress is, therefore, unique to each of us. That explains why two employees can experience the same stressors at work but react to them differently. Most of us, however, can agree that some things are inherently stressful. In the workplace, stressors that can be possible causes of employee burnout include feeling either permanently overworked or under-challenged, being under time pressure, or having conflicts with colleagues. As PubMed Health warns, “Extreme commitment that results in people neglecting their own needs may be at the root of it [burnout].”

The Mayo Clinic suggests that employee burnout may be caused by many workplace stressors, including:

• Lack of control: The employee feels unable to influence key decisions that affect him or her directly, such as his or her work schedule, assignments, or workload.

• Lack of resources: The employee cannot get the tools, supplies, or other resources that are needed to do his or her job properly.

• Unclear or impossible job expectations: The employee is unclear about the degree of authority he or she has or what the boss or others expect. Or, unreasonable expectations have been placed upon him or her.

• Dysfunctional workplace dynamics: For example, the employee works with a bully, feels undermined by coworkers, or has a boss who micromanages his or her work.

• Mismatch in values: The employee’s values differ from the way his or her employer does business or handles grievances.

• Poor job fit: The job doesn’t fit the employee’s interests and skills.

• Extremes of activity: The job is too slow, monotonous, frenzied, or chaotic.

• Lack of social support: The employee feels isolated at work and/or in his or her personal life.

• Work–life imbalance: Work takes up too much of the employee’s time and effort, leaving little or nothing left to spend with family and friends or pursuing other interests.

The High Cost of Employee Burnout

Employee burnout can be costly for a medical practice. It can transform top-performing employees into indifferent, frequently absent, ineffective workers. Meinart(9) suggests that the impact on the employer’s bottom line can be significant, because burnout can result in lower productivity, lower engagement, and higher turnover. However, there is more at stake for a medical practice with burned out employees than simply declines in performance. Besides the obvious consequences of burnout, there is also the potential for a great loss of knowledge, expertise, and creativity. As Gaither(10) aptly puts it, “A person’s vitality and creative force will be stymied or destroyed by burnout. Someone’s passion and sense of purpose can be completely subverted.”

Burnout is a huge risk for the employee’s health and well-being.

A medical practice will lose the benefits of having a burned-out employee’s innovation and ideas, and will miss out on so much that the employee could be giving to the practice, to his or her coworkers, and to patients. Additionally, an employee who is burned out is likely to have a negative impact on everyone else who works in the practice. Coworkers will have to pick up slack, correct the employee’s errors, and work extra hard not to succumb to the negativity coming from the burned-out employee. It can be challenging for everyone else to remain upbeat, energetic, and optimistic when a member of the team is experiencing burnout.

Ignored or unaddressed job burnout can have even more devastating consequences for the employee who is experiencing it. The Mayo Clinic warns that burnout can lead to excessive stress, fatigue, insomnia, a negative spillover into personal relationships or home life, depression, anxiety, alcohol and substance abuse, heart disease, high cholesterol, type 2 diabetes (especially in women), stroke, obesity, and vulnerability to illnesses. Burnout Solutions(11) suggests that burnout can cause nightmares, phobias, and an increased risk of infection, and that, at its worst, hospitalization is “often essential.” And according to Bailey,(12) many studies show that burned-out employees have lower cortisol levels than their peers. Because cortisol helps restrain activation of the immune system and other components of the stress response, Smith explains, a deficit may disinhibit immune function, leading to hyperactivity of innate immune inflammatory responses. Alarmingly, there is an increased recognition in the literature that inflammatory processes are central to the pathogenesis of chronic diseases, including cardiovascular disease, diabetes, and cancer, Bailey warns. Clearly, burnout is a huge risk for the employee’s health and well-being.

Twenty-five Ways to Prevent Employee Burnout

No medical practice manager wants to lose his or her best employees to burnout, for the reasons cited above, plus one more: it is painful and draining to watch any person you care about succumb to burnout. Below are 25 strategies you can use to prevent burnout among the members of your medical practice team.

1. Create a supportive practice culture. Make sure that being supportive is a value in your medical practice. Model supportive behavior. Reward and call attention to employees who exemplify your supportive culture. Don’t tolerate cattiness, exclusive cliques, or gossip. Address immediately any behavior that is not in line with your practice’s value of supportiveness.

2. Be realistic when assigning tasks. Delegate an amount of work that is challenging, but not overwhelming.

3. Clarify your expectations and job requirements. Make sure that every employee understands his or her role, and how his or her duties fit into the larger picture of your medical practice.

4. Emphasize the positives. Speak to your employees about the work that most excites them. Keep what your employees enjoy most about their work at the top of their minds. Remind them regularly of the valuable difference they are making to their team, and through their hard work.

5. Limit overtime. Get your employees in and out of the office in the number of hours that was agreed upon at their hire. This may mean decreasing their workload, hiring temps, or hiring another employee.

6. Be sensitive to differences. Don’t ask employees to complete tasks that may challenge their values or that elicit ethical concerns.

7. Consider the traits of your employees. Identify which members of your team are more sensitive to criticism, which are the most skeptical, and which are the perfectionists. These traits can make employees more prone to feeling that they’re never good enough. Employees who have them can be less likely to bounce back from loss of control or failure. Learn which strategies work best with these employees.

8. Encourage friendships. Employees who know and like one another are more energized and motivated, and, therefore, less likely to burn out. Encourage employees to socialize freely on breaks, at lunch, or after work.

9. Be inclusive. Involve your employees in decisions that are directly relevant to their work. Motivate them to participate in practice-wide decision-making when appropriate. Keep them informed of changes that will affect their jobs.

10. Communicate. Meet with employees regularly, both as a team and individually. Give them a chance to discuss not only what they are working on, but also any issues they may have concerning their workloads, the difficulty level of their work, the work environment, and their career goals. Allow time and opportunities for your employees to open up to you. Let them know that you are their advocate and that you are on their side.

11. Limit stressors. For example, don’t ask an employee to take on a new challenge when he or she is in the middle of a demanding project. Acknowledge times when things are especially stressful in your practice. Explain what you are doing to ensure that a stressful situation will be resolved as quickly as possible.

12. Equip your employees with the proper tools and resources. If you’re not sure what they need, ask them.

13. Value vacations and other paid time off. Encourage or require employees to use their allotted vacation time, and to stay home when they are too sick to work. Run reports to ensure that your employees do not have excessive balances of unused time.

14. Model good balance. For example, close your practice early before holidays. Stay home and take the time you need to recover when you are too sick to work. Use all of your vacation days.

15. Be generous with gratitude and praise. Make a big deal of it when an employee receives a compliment from a patient. Highlight the thank-you notes, comments, and e-mails you receive. When an employee has done something extraordinary, draw everyone’s attention to it, and send a letter home so he or she will know how much you appreciate him or her. Smile often and say great work and thank you for doing that. Sincere, well-timed praise still goes a long way with employees. Find reasons to build employees up on a regular basis, and tell them the good things you’ve observed.

16. Encourage stress relievers. For example, make your staff break room a place where employees can take a restful and restorative break.

17. Demonstrate your appreciation. Do something nice for your employees every now and then that they don’t expect. For instance, bring breakfast for your staff one morning. Give everyone on your team a motivational or inspirational book that you think they’d enjoy. Or, give each employee a $5 gift card to a local coffee shop.

18. Schedule team building activities. Build team morale, inclusiveness, and job satisfaction by scheduling staff outings that encourage bonding. Be creative and make it fun.

19. Be sympathetic. When an employee expresses frustration or concern, address it immediately. Make sure that he or she knows that you are taking appropriate action. Or, if you can’t, explain why you can’t meet the employee’s needs.

20. Ask for help. Establish a “when you see something, say something” policy for your staff. Encourage employees to alert you when they suspect that a coworker may be burning out.

21. Educate and train. Employees want to feel that they can excel in their jobs and achieve more. Provide opportunities for education and training that will improve their job skills and make them feel more confident. Also consider providing stress education for your employees so they learn healthy ways to deal effectively with stress.

22. Resolve workplace conflicts. Conflict that goes unresolved for too long can result in burned out employees. Make it your priority to manage, mediate, and resolve conflicts quickly.

23. Encourage healthy behaviors. You can’t hope to prevent burnout if the way your practice operates encourages it. Get some fresh air during your breaks and encourage your employees to do the same. Go for a short walk. Bring in healthy treats for special occasions. Encourage employees to drink plenty of water.

24. Let employees do what they do best. Nothing is more disheartening than being in a role you hate or that you aren’t very good at. Make sure your employees love what they do as much of the time as possible. Identify where their strengths and interests lie. If employees are misaligned with their jobs, adjust assignments or move them into roles they’re more passionate about. If you can’t, counsel them to seek work that better suits them. Then, improve your hiring practices so you don’t hire misaligned employees again.

25. Keep things interesting. Routine is a double-edged sword. It helps things run smoothly in the practice. But it can also become dull. Change things up when you can. For instance, offer a different kind of birthday lunch for employees each month. Run a new staff contest. Designate “spirit days” in your practice when employees can dress up. Or, engage a surprise guest speaker at a staff meeting.

What to Do When You Suspect That an Employee is Burned Out

As soon as you suspect that an employee is experiencing burnout, create a list of everything you’ve observed that has led you to think this. Recall the employee’s particular expressions and body language, things the employee said or did, changes in punctuality and attendance, and other changes you’ve observed, preferably noting when you observed them. Also note similar observations about the employee that others have shared with you. Do your best to identify when you began to notice the changes.

Meet with the employee in private. Express your concern about the changes you’ve observed in him or her. Then describe specifically what you’ve observed, without attaching judgment to it. When you’ve gone over everything, reiterate your concern. Then ask the employee if he or she knows what’s going on. Give the employee an opportunity to speak, even if he or she doesn’t speak up right away. Don’t fill up the air space by talking. Remain silent. If the employee finally opens up to you, don’t interrupt or react negatively. Let the employee get everything out.

Based upon what the employee tells you, or if he employee doesn’t speak at all, suggest that he or she see a doctor as soon as possible to figure out what is going on and what kind of help may be needed. Do not diagnose the problem. For instance, don’t tell the employee that he or she is burned out. A doctor needs to examine the patient and possibly run some tests to get a better read of the situation. Of course, if the problem turns out not to be a physical, mental, or emotional problem, and it is burnout, work with the employee to find a solution that works for him or her and for the practice. Be compassionate and do what you can. Remember, however, that a burned-out employee cannot take the practice down with him or her. The issue has to be resolved, even if that means ultimately that the employee cannot continue to work in the practice.

References

1. PubMed Heath. Depression: what is burnout? PubMed Health. January 12, 2017. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/ . Accessed September 5, 2017.

2. Burnout on the job is on the rise. WSJ Video. February 28, 2017. www.wsj.com/video/burnout-on-the-job-is-on-the-rise/2E8A3EB7-7465-4F6E-8ADF-395DEC26BBA1.html . Accessed September 5, 2017.

3. Rampton. J. Successful business leaders focus on preventing employee burnout. Entrepreneur. July 11, 2017. www.entrepreneur.com/article/296591#. Accessed September 5, 2017.

4. Scott E. How to tell you’ve reached the point of burnout. VeryWell. June 27, 2017. www.verywell.com/stress-and-burnout-symptoms-and-causes-3144516 . Accessed September 5, 2017.

5. Mayo Clinic Staff. Job burnout: how to spot it and how to take action. Mayo Clinic. September 17, 2105. www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/burnout/art-20046642 . Accessed September 5, 2017.

6. Carter SB. The telltale signs of burnout . . . do you have them? Psychology Today. November 26, 2013. www.psychologytoday.com/blog/high-octane-women/201311/the-tell-tale-signs-burnout-do-you-have-them . Accessed September 6, 2017.

7. Symptoms of burnout syndrome. Right Diagnosis. September 6, 2017. www.rightdiagnosis.com/b/burnout_syndrome/symptoms.htm#symptom_list . Accessed September 6, 2017.

8. Stillman J. Five surprising signs of burnout. Inc. June 11, 2013. www.inc.com/jessica-stillman/5-surprising-signs-of-burnout.html . Accessed September 6, 2017.

9. Meinart D. How to prevent employee burnout. SHRM. July 19, 2017. www.shrm.org/hr-today/news/hr-magazine/0817/pages/how-to-prevent-employee-burnout.aspx . Accessed September 5, 2017.

10. Gaither C. 6 Causes of job burnout you absolutely must know. Clark Gaither, M.D. aka Dr. Burnout. www.clarkgaither.com/6-causes-of-job-burnout-you-absolutely-must-know/ . Accessed September 5, 2017.

11. Burnout phases and consequences. Burnout Solutions. http://job-burnout.eu/burnout-phases-consequences/ . Accessed September 6, 2017.

12. Bailey JS. Burnout harms workers’ physical health through many pathways. Monitor on Psychology. June 2006. www.apa.org/monitor/jun06/burnout.aspx . Accessed September 6, 2017.

Burnout and Depression: What’s the Difference?

Certain symptoms that are considered to be typical of burnout also occur in clinical depression. These include:

• Extreme exhaustion;

• Feeling down; and

• Reduced performance.

Some people who are experiencing such symptoms may believe incorrectly that they are burned out, when, in fact, they are depressed. That is why medical practice managers must be very careful not to assume that any employee is burned out. This could lead to unsuitable remedies or discourage an employee who has depression from seeking needed treatment.

For instance, employees experiencing the symptoms above may be advised to take a longer vacation or more time off from work. Those who are simply overworked and exhausted because of work can usually recover if they follow that advice. But if an employee has depression and takes a longer vacation or more time off from work, doing so may actually make matters worse. The help a depressed person needs is very different and often includes psychological treatment and/or medication.

Some characteristics of burnout are very specific, though. For instance, in burnout, most of the problems are work-related. In depression, negative thoughts and feelings aren’t just about work, but about other areas of the employee’s life. Other typical symptoms of depression include

• Low self-esteem;

• Hopelessness; and

• Suicidal thoughts.

These are not regarded as typical symptoms of burnout.

Bottom line: Employees experiencing burnout don’t always have depression. But burnout may increase the risk of an employee falling into depression.

Depression: What is burnout? PubMed Health; January 12, 2017. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/ . Accessed September 5, 2017.

How to Avoid Burnout

Medical practice managers are no more immune to job burnout than anyone else. Here are six strategies that you can use to avoid burnout:

1. Work with purpose. Do you feel that your career in medical practice management has a deeper purpose, other than just earning a paycheck? Discovering or rediscovering your purpose can go a long way toward helping you avoid burnout and keeping stress at bay. Look at the deeper impact of what you do every day. How does your work make life better for other people? How could you add more meaning to what you do?

2. Analyze your job. When you experience work overload day in and day out, you can start to feel as if you’re on a never-ending treadmill and that you’ll never catch up. This is demoralizing, stressful, and often leads to burnout. If you feel that your boss is assigning more work than you can handle, or simply has unreasonable expectations, schedule a private meeting to discuss the issue. Let him or her know that your excessive workload may be leading to burnout. Come prepared with options that could be considered for shifting certain tasks or projects to someone else.

3. Give to others. One quick and easy way to add meaning to your career is to give to others. Even the smallest act of kindness can re-energize you and help you find meaning in your work.

4. Take more control. You can avoid or overcome burnout by finding ways to create more autonomy in your role. Talk to your boss to see if he or she is willing to let you have more control over your tasks, projects, or deadlines.

5. Exercise regularly. Exercise can help alleviate stress and create a sense of well-being. You will also experience increased energy and productivity when you exercise regularly. What’s more, regular exercise will help you get a good night’s sleep.

6. Learn to manage stress. There are several strategies that you can use to cope with stress. For instance, you can keep a stress diary to document what routinely causes you stress. Practicing deep breathing, meditation, and other relaxation techniques can help you calm down when you’re experiencing stress. Practicing positive thinking can also help you get through stressful times.

Avoiding burnout: maintaining a healthy, successful career. MindTools. www.mindtools.com/pages/article/avoiding-burnout.htm . Accessed September 7, 2017.