The Research on Reducing Health Worker Burnout

Evidence points to what’s needed at individual and organizational levels

Published: Wednesday, November 2, 2022 - 11:01

Emergency medical workers, already at increased risk for burnout compared to other professions, continue to be challenged by the fallout of Covid-19.

Stretched to the breaking point by increased workloads, highly contagious and acutely ill patients, and limited resources, workers’ risk factors for burnout have been amplified.

One obvious solution is to fix critical staffing shortages. But emergency health worker burnout was an issue before pandemic-driven staff shortages, and will likely continue into the future.

There is no easy fix, but the World Health Organization has been calling for action to better protect workers because many are leaving the profession.

What is burnout and how prevalent is it?

Burnout is a workplace syndrome characterized by feelings of exhaustion, depersonalization (a sense of detachment and that one’s surroundings are not real), and compromised work performance, according to the WHO’s International Classification of Diseases.

Researchers at the BlackDog Institute propose additional fundamental symptoms, including lack of feeling, lack of concentration, and lack of motivation, among others.

Burnout has previously been reported to be experienced by anywhere from 26 percent to 82 percent of clinicians working in emergency departments, much higher than other areas of medicine and the general workforce. But during the Covid-19 pandemic, these figures were found to be consistently high, between 49.3 percent and 58 percent.

What does the research say about fixing it?

Despite the common self-help resources available online, there is only a modest amount of high-quality scientific evidence for how to address burnout in emergency medical workers.

Several systematic reviews of interventions broadly categorize interventions in two types:
1. Individual-focused, such as mindfulness or small group stress-management education.
2. Organizational-focused, such as: limiting shift lengths, flexible working arrangements, and building a positive workplace culture.

Both types of interventions can lead to a meaningful reduction in burnout among health workers.

At the organizational level, a recent, high-quality study concluded organizations needed to take more ownership of implementing effective burnout-reduction strategies to make workplaces less stressful and more supportive of workers’ mental health.

There’s also some evidence for job training and education, such as training by qualified psychologists on coping strategies, in reducing occupational stress and burnout compared to other organization-based interventions.

A paper on the determinants and prevalence of burnout in emergency nurses found evidence of the need for a “good person-environment fit,” where a person’s values, beliefs, and personality traits match the norms of an organization to prevent burnout.

On an individual level, mindfulness-based interventions, in which people develop the ability to be present in the moment and not judge their experiences, have been found to be effective. Another study of nurse burnout also found implementing mindfulness-based interventions as well as other positive-thinking training at regular intervals was key to ensuring long-term change.

Several studies have found a combination of individual and organizational-level interventions have the greatest effect for general medical workers. For instance, studies have reported that implementing physician-targeted interventions like exercise and mindfulness techniques alone do not have a significant effect on burnout reduction but can be effective at reducing burnout when combined with organization-directed interventions, such as good communication, interdisciplinary collaboration, and team spirit.

Specific to the Covid-19 pandemic, studies of workers in ICU and ED found that work environment, communication, and support by supervisors had an established role in burnout both before and during the Covid-19 pandemic. One study suggested organizations need to engage their workforces, listen to their concerns, and design targeted interventions based on the specific needs of their staff.

Finally, a study of nurses during the Covid-19 pandemic found that the psychological support healthcare workers receive significantly influences their feelings and emotions, and can support their ability to handle the negative effects and challenges of their work. It also found that social support from family, friends, co-workers, and their organization can help workers control and avoid negative feelings and emotions that can lead to burnout.

What are the caveats?

There are notable limitations in current research. For instance, evidence about organizational interventions is limited. Studies evaluating individual targeted interventions to reduce burnout are more common than organizational interventions because they are easier to implement.

Moreover, two studies found the overall sustainability of the effects of interventions is poorly understood. Lastly, a study focused on medical workers more generally and comparing person-directed versus organization-directed interventions found that some organizational interventions don’t target burnout directly or may have unintended effects on other factors that shape burnout.

For “The research on” series, 360info works with experts to rapidly scan quality research and present the most current scientific evidence addressing global challenges. This article is based on a rapid scan of systematic reviews focused on interventions to support emergency medical workers experiencing burnout, as well as interventions for medical workers more broadly. The scan was undertaken by a special Evidence Review Service at Monash University.

First published Sept. 9, 2022, under Creative Commons by 360info.

About The Authors

Alex Waddell

Alex Waddell is a behavioral scientist and researcher at Monash University.

Diki Tsering

Diki Tsering is a research scientist with a background in business and environmental science. 

Peter Bragge

Peter Bragge is a research scientist and author focused on sustainability practices.

Paul Kellner

Dr. Paul Kellner is a research fellow at BehaviourWorks in Australia. He also has a background in psychology.