Thank you all for joining session 225. Today we're going to be talking about occupational burnout. And my name is Dr. Jerry Strohkorb. I'm the global medical advisor for Kindral Corporation, which is a global multinational company, 80,000 global employees, 63 countries of the world. We do IT services. They call us the world's biggest startup. We just broke off from IBM a few years ago. All righty. Just want to let you all know there are no conflicts of interest to disclose. All righty. Just to start a little bit by telling you about myself. I already mentioned my job. I've been in occupational medicine and public health for 23 plus years. And I'm happily married and have two daughters who are 21 and 18. They're a great support system. In kind of the vein of this talk, especially towards the end, we'll be talking a lot about strategies for trying to reduce the risk regarding preventing burnout. And so in vein of that, I'm just going to share with you some of my personal interests because developing personal interests and having your time in more things than just your work is actually a good strategy for helping to reduce burnout. So friendship is a high priority to me. So spending time with friends is actually a really great way for me to decompress and blow off stress and things like that. I'm also a fine artist and I'm a gallerist as well. So that gives me great joy to make art. I love exercising, weight lifting, and I love to speak and learn different languages as well. Some of the art you'll see in here are actually some of my pieces. All righty. So some of the learning objectives that we'll try to cover during this session. We're going to identify the characteristics of occupational burnout, try to put more clarity around what that means. We'll describe the stress response, kind of distinguish what acute versus chronic stress are and the risks for stress related diseases. And then of course, try to apply some clear strategies for reducing the risk of burnout to workforce populations and strategies for intervening. So actually before I go there, I'll just give you a little bit of backdrop. In my role with Kindrol, we're a tech company. So in the past, I worked in the oil and gas industry where the levels of physical risk were very high. In Kindrol, we're a tech company. Most of the workers are office-based workers. So the risks are different. The risk profiles and things that I'm focused on, it's a different risk profile. So there's ergonomic issues. There are more mental health conditions, chronic diseases, things like that. So this past year, I've been very involved in doing talks and sharing information around how to reduce work stress and how to prevent burnout, which is kind of where this talk came from. So the first thing we have to ask ourselves is try to get some clarity around what is stress. And stress is not a diagnosis or a disease. The best definition I could find was a state of mental or emotional strain caused by adverse circumstances. One thing to say is stress is on a continuum. So there's good stresses, and then there's bad stresses. We all actually need stress in our lives. It actually helps us to improve our performance, be able to focus, be more motivated, et cetera. But there does come a point where as stress is increasing, you get to this peak performance where your performance will actually start to decline if you're in chronic states of stress for too long. Things such as fatigue, exhaustion. You can even develop mental health conditions, burnout, et cetera. I think the data that I looked at, and it changes because survey data changes, but at least 33% of adults actually say they're in high levels of stress right at that moment. So in any cross-section of time, it's a fairly high percentage of people. Probably many of us here are in that category too, I would think. So I think the main thing to think about is stress is actually good for us. We need it to grow. We need it to perform. But there are also points where stress becomes chronic, and you have to think of strategies for reducing that stress for yourself as well as for your patients and for your populations that you're supporting. So to kind of get a feeling for what does stress look like, what is this picture around the world, there was a survey that was recently done, X-Acts 21-22. So this is kind of still post-COVID, still fresh in the minds of people, 122 countries. So it was a fairly large sample. And basically what they asked is, have you been stressed in the previous days before the survey? And the max countries that you would imagine would be stressed, countries that have war or have difficult circumstances in the countries, of course, you would imagine probably have higher levels of stress. The U.S. was actually number 12 at 53 percent of the people surveyed said that they had high or significant levels of stress within the past few days. That's pretty high. Some of the most common stressors that were reported, and I'm sure that this is probably common around the world as well, but this is a specific U.S.-based data. A lot of people were worried about inflation at the time, you know, post-COVID. Inflation rates were going up really high, the cost of living was increasing. Global supply chain issues, global uncertainty. And then, of course, you can see there at the bottom, 41 percent of people were complaining of ineffective company communications and boss-related stress. So things related to their jobs, in other words. Some of the key stressors in the American workplace, based on data that was actually collected this year, includes 41 percent, you know, complain of poor communication that's contributing or causing their stress, 40 percent of team members, you know, or 40 percent complain that there were team members not actually pulling their weight in projects, 39 percent complained of workload, which is definitely a component, 27 percent experienced bottlenecks where they're waiting for a process to go and they're waiting on someone to get their step done. Twenty-six percent unrealistic deadlines, and 26 percent being overloaded. So kind of a, you know, summary overall, there's a very high prevalence of work stress is kind of the idea. In this data, 83 percent experienced high levels of work stress, and 56 percent actually reported that that stress was reducing their productivity at least five hours or more per week. That's pretty significant. Fifty-one percent affects, it affects 51 percent of their relationships at work, and greater than 50 percent also experienced kind of disengaging the work due to work stress. One in four workers actually reported, you know, that they felt like they were going to burn out this year, and 63 percent actually reported they were ready to quit. So it's actually very common. So there are a lot of impacts of workplace stress. Of course, I'm going to talk about burnout as one of the things that can happen, but we're just still talking about workplace or stress in general. You know, there's a lot of effects on, various effects, effects on relationships. Seventy-six percent report their workplace stress actually has a negative impact on their relationships. Seventy-five percent can experience physical symptoms, loss of sleep, feeling more lonely. Thirty-two percent reported having suicidal thoughts. Pretty extreme. And job stress actually costs the U.S. The estimate is $300 billion plus every year due to absenteeism, diminished productivity, and accidents, all related to work stress. It's a significant issue. So I know you all are already very familiar with the stress response system, but also I'll just touch on it quickly. So of course, there's the flight, fright, or flight. Our stress response system really is there to help us to survive imminent threats and imminent danger. So acute stress is there to help us to survive. In the states that we're living in now where our stresses are not acute, they may be acute, but they're often chronic. So we're at high levels of stress all the time. These systems really aren't meant to be charging like this all the time. So you can see all the major effects when your body releases, you know, stress hormones, cortisol, and adrenaline, et cetera. You know, you'll have all these immediate effects to the systems of the body. There's physical effects, emotional effects, behavioral effects. There's many things that can happen in the acute phase of stress, and we've all experienced it. I, right now, I'm up here talking, and I'm having a little bit of clammy palms, for example. And we've all experienced this, various aspects of how we experience stress. But I think it's important also to know people have emotional impacts, can change your mood, can lead to anxiety or depression, feelings of sadness or even anger or irritability. And then also, you know, we have ways of coping with stress, and not all of those ways are necessarily the best ways. So sometimes I like to overeat. I have a drive to eat when I'm stressed. Some people undereat. You can have angry outbursts or use substances inappropriately, for example, et cetera. There are a lot of different stress-related illnesses. So just general stress can increase the risk for, for example, depression and anxiety. The risk goes up that you'll have a major depression episode of at least 20 to 25 percent if you go through a major life stress. That's just the general population rate. For example, loss of a job, loss of a child or a spouse, a divorce, et cetera. Insomnia is at a very high rate, persistently in the 40 percent range where many people are struggling with not able to sleep regularly. Cardiovascular disease is actually, your risk is 50 percent higher if you're, you know, chronically stressed. And then there's a whole list of other things that are all increased related to stress and the way that that stress kind of impacts your body and then chronically can lead to many of these types of diseases. The immune system, I mean, we all know, we've all, we all feel it. When you're stressed for a week or two, you feel yourself coming down with a cold. So your immune system is weaker. Probably that cortisol is actually suppressing your immune system for short-term. All righty. I want to kind of touch on, since we're talking about burnout, you know, it is kind of co-related to mental health. And so I wanted to kind of give a picture around that. Mental health is, you know, very common around the world. The WHO estimates 13 percent globally have some mental health condition, a billion people in the world. And almost 600 million have just, you know, the main two, anxiety or depression. Around a trillion dollars in lost productivity each year based on mental health conditions. And during recent surveys, during the pandemic, for example, where stress, stresses can get even heightened, 50 percent of people reported psychological distress, you know, around 36 percent just stress. And then there were 28 percent actually who reported depression, 27 percent anxiety, 24 percent more PTSD symptoms. So the, say, if the standard rate's 13 percent, it can actually go up if we're having a global, you know, threat like COVID, for example. The whole topic of burnout kind of came more to the forefront back in 2019. The WHO actually published their official definition of what occupational burnout is. And a big part of that was their great concern around healthcare worker burnout that they had been noticing around the world. And of course, we all know that it grew even greatly worse during the COVID pandemic where many medical providers were, you know, basically quitting because they just could not do that level of stress. You can see some of the stats here. Forty-four percent of physicians experience symptoms of burnout. About a third of nurses report high burnout levels. Twenty-nine percent of the physicians say that their burnout's related to insufficient compensation for what they're doing. But a high percent also is related to their feeling of a lack of control over their environment. Another part that's probably exacerbating those symptoms is, you know, 45 percent of healthcare workers are getting less than seven hours of sleep a night. So if you're not sleeping well, that's just going to just exacerbate that stress even more and how it impacts your body. I want to talk a little bit about the Karasek Demand Control Model. Dr. Karasek worked on studying how job demands relate to decision-making latitude. So how much job autonomy do I have to make decisions versus how much, how high is my workload? And so what he found, you know, in, you know, very valid ways was that high levels of work demand with high levels of control, it actually can be a recipe for job satisfaction. These are people who are in active, it's called the active job phase, where they can often be very satisfied with their work, learning, motivate, being motivated to develop new behavioral patterns, et cetera. Versus very high levels of workload with low levels of control is a huge risk for burnout. It's considered the high strain job. It's a great risk for psychological and physical stress and all of those things that I just mentioned around stress. So that's one. We're going to touch on this later, but control or the ability to make decisions can actually reduce the risk for burnout. So it's really an important concept without even changing the workload. Of course, we probably all know about common workplace stressors. This is data, I believe, from the WHO as well. Low pay, long hours, you know, fewer opportunities for advancement, tedious, uninteresting work, et cetera. Lack of control over job-related decisions, so that was one I just mentioned. The way an organizational culture works and, you know, whether there are bad management practices or it's a toxic work environment, et cetera. Those can all contribute in the workplace. So as we're thinking about stress and we're, you know, looking at ourselves or looking, you know, trying to help our own workers and patients, you know, it's good to have some tools to try to, you know, have some type of objective way to look at it and measure your stress. So this is one thing you could actually do just sitting in your own seat right now. For each of these questions, answer never, almost never, sometimes, fairly often, or very often, and give yourself a point score for each one of these questions and then add up the points at the end. So how often have you been upset because of something that happened unexpectedly? Usually you would also frame it within a time period, like within the last week. How often have you felt that you were unable to control the important things in your life? How often have you felt nervous and stressed? How often have you felt a lack of confidence about your ability to handle your personal problems? How often have you felt that things were falling apart, not going your way? How often have you found that you could not cope with all the things that you had to do? How often have you been unable to control irritations in your life? I'm from Texas, I'm Houston, so one of those big ones is traffic, man. That irritates me on a daily basis. How often have you felt that you are not on top of things? How often have you been angered because of things that happened that were outside of your control? And how often have you felt difficulties were piling up so high that you could not overcome them? So now add up your point score. So if you're generally scoring in the 0s and 1s, you're in the low stress realm. If you're scoring 1s, 2s, and 3s most often, you're probably in the moderate stress realm. And if you're scoring mostly 3s and 4s, then you're considered in the high stress realm. So this is not meant to diagnose any medical conditions, it's just really a way to monitor. You can actually give this even to your patients to check their levels of perceived stress, for example. And then I think an effective thing to do is if someone's stress levels are high, then you can try to get to the root of why that is and try to strategize ways to lower stress. So they can test themselves again and hopefully their stress is lower. So now we're building this kind of building, or we've got the foundation laid, what is stress, et cetera, and how it impacts. Now let's kind of bleed into what is occupational burnout. So according to the WHO, burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions, feelings of energy depletion or exhaustion, increased mental distance from one's job or feelings of negativism or cynicism related to one's job, and reduced professional efficacy. So it is considered an occupational phenomenon, it's not technically a medical condition. But the ICD-11 does now include the specific code for occupational burnout, which can be concluded as a secondary diagnosis, not as a primary diagnosis. So if I were to ask people here, if you have even one of these symptoms or these criteria, raise your hands. I mean, look around, I think a lot of us experience these. Some of the ways that occupational burnout will present include difficulty concentrating, people may have a depressed mood, feelings of worthlessness, loss of interest or pleasure, suicidal ideation. It sounds pretty similar to depression, doesn't it? So there's a lot of overlap. So burnout does share symptoms, of course, with depression, it can be very similar. And depression, of course, is a condition that needs to be treated. But the difference would be if the feelings are specifically related to the job versus generalized to the person's life. So it can happen in various phases. As the level of stress, chronic stress, is continuing and someone's trying to respond to that. The first phase is called the emotional exhaustion phase where someone all of the excessive demands workloads and sometimes difficult interpersonal relationships can can cause emotional exhaustion where the person literally just feels like they're working too hard and they have more bad days than good days. Additionally as that stress continues and they pass that initial emotional exhaustion they can start to enter this depersonalization phase where they start feeling very cynical and have almost an insensitive attitude towards their job and colleagues. They simply just stop caring like they don't care. And then phase three it can start to impact their personal accomplishments. So how they're actually performing in the job. Burnouts can actually start to go down in other words. So some of the effects related to untreated burnout symptoms can include some of these things such as alienation. So if you for example if you have your own staff that you're monitoring or you want to develop policies or ways to educate your managers in your workplaces around this issue these would be some of the things that they would want to look for in their own workforce. So if they notice that their employee is starting to alienate themself from work from work related activities the person views their job as increasingly stressful or frustrating and they notice growing negativity and cynicism and emotional distancing from their colleagues and from their work. If their performance actually starts to go down they're already into that phase three. So that's often when you know managers will take notice that their employee is not doing well where the person is feeling negative about their tasks having difficulty concentrating often lacking creativity and their performance can actually start to go down. Of course we mentioned a lot of the physical impacts you know around the stress response system some of the key ones insomnia which can then exacerbate how people manage stress depression and anxiety are very commonly correlated and then other many other medical conditions that I mentioned can can be exacerbated as well. Another really interesting phenomenon is they've noticed that if you don't intervene and really help the worker that's having symptoms of occupational burnout it is actually there's evidence of it being a type of social contagion. You'll actually have many other people who will start to also have similar symptoms. It will kind of register with others. So there's this sense of influence in other words. It's really a kind of a thing to be watching for and and doing the right things to help intervene. Some of the risk factors for occupational burnouts we talked a lot about different things so I'm going to just go through a simple list here unreasonable time pressures employees who say that they have enough time to do their work are 70 percent less likely to experience burnout. So it's a resourcing issue. If the person's if there's so much workload chronically piled on there's not enough people person to do that to that task in other words. There are ways to strategies you can implement such as make that those those person's tasks more efficient. You know take away unnecessary tasks that they don't really need to do that aren't providing value and make their job you know try to bring the job demands down in other words. Another one lack of manager communication and support. So relationships with and between employees and managers are one of the most important relationships in the occupational environment. I think a lot of studies show that people don't actually quit their jobs they quit their manager. The manager is that important. People who feel strongly supported by their manager are 70 percent less likely to have burnout. So really fostering that relationship between employee and manager is very very important. A lack of role clarity. Sometimes there can be confusion among the employees about what they're actually supposed to be doing. So if the workers actually the data show that only only 60 percent of workers actually know what is expected of them. And so if our expectations as managers or within your own company are unclear or moving targets employees just get exhausted simply trying to figure out what they're supposed to be doing. So having really clear list of roles and role clarity can be helpful. People can engage their workload and things like that. Of course we all know unmanageable workload. You know there's people who can feel overwhelmed with the workload so high that they they just don't they lose hope that they can ever complete. So one of the one of the strategies for that one would be trying to break up tasks into smaller parts that then the person could experience a sense of reward for smaller pieces of their tasks in other words. Of course unfair treatment is I think an urgent and it needs urgent intervention. So if an employee has a perception that they're being treated unfairly in the workplace there are 2.3 times more likely to experience a high level of burnout. So when I say unfair treatment there's perception of favoritism unfair compensation or mistreatment from a co-worker that's then not being punished by the supervisor things like that. And then another one that's important to mention is we all have our own innate qualities as well that can contribute to burnout. So you know personality traits and thought patterns can actually make you more at risk if you're a perfectionist probably many people in this room or if you're a natural pessimist have a tendency to see the glass as half empty. Chances are you're going to actually have a higher risk for you know for contributing to the to the stress on yourself. So going a little easier on yourself not trying to be perfect at everything actually can help you reduce your risk. There's actually a body of literature around trust and there's a really great article in the Harvard Business Review around the neuroscience of trust and I put the links in the back to that. If a level of trust was shown to significantly impact intentions to quit as well as burnout an individual's trust in his or her organization and perceived organizational trust both moderated the relationship between exhaustion and intentions to quit. So if a worker has to work really hard in their job but they trust their employer and their manager they're likely unlikely to get burnout. It's very protective. So if the relationship is good there then that's highly protective. So there are actually behaviors that can be demonstrated and practiced in organizations to try to build higher trust organizations. The data is actually really powerful and actually I'll go to that first here. So people at high trust companies report 74 percent less stress 106 percent more energy at work 50 percent higher productivity 13 percent fewer sick days 76 percent more engagement 29 percent more satisfaction with their lives and 40 percent less burnout. So trust is key. And so we'll talk about some of these ways that we you know we all could demonstrate for our own staff or even within our own organizations teaching managers and leaders how to how to show behaviors that demonstrate trust. It actually triggers pathways in a person's brain. So oxytocin pathways are triggered when these behaviors are demonstrated. And so it can be very powerful regarding reducing the risk of burnout but also improving productivity for your staff and your workers. So some of these include things like if someone does something great recognize excellence publicly give people credit for their work that they've done induced challenge stress. It's that the idea that I just mentioned where you break things up into smaller doable parts so people can actually have a smaller piece to accomplish and then have a sense of reward for that piece and then move to the next piece and the next piece. So it's really building attainable goals that people can then feel rewarded for micromanaging. So I think we've probably all experienced this in our careers micromanaging has to do with that control demand model. So if I within my own realm and not allowed to make any decisions at all and I'm being intervened by a manager who's hyper meticulously managing everything I do it basically will create that and create incredible risk for burnout from being a high level of workload and a low level of control giving your workers a sense of a sense of some things they can control actually helps them reduce their risk for burnout. So that's an important concept. The other thing I think that's really important is it actually autonomy can actually promote innovation people many people think differently. So if if we like loosen the reins a little bit in the areas that are appropriate of course you often will find that processes become more efficient and people think of new ways to do things that actually will help your organization as a whole job crafting. So basically what this means is employ you give employees the right to choose what they would like to work on. So if you have a list of things that need to be done allow people to volunteer for those things that they really feel passionate about. People are much more likely to want to work hard and not get burnt out if they really like what they're doing in other words sharing information broadly. So in the data only 40 percent of workers felt that their company communicated enough. So the vast majority don't feel communicated to. So sharing information broadly can actually help your workers reduce their risk for burnout because their level of trust is increasing. So engagement actually what they've shown in the data is daily communications from maybe it seems excessive but there's this relationship between increased communication and increased engagement among the staff and when engagement increases productivity increases and all of those other stats start to go down. People are happier in their jobs less likely to have burnout intentionally building relationships of course appropriate that are based on kind of having an interest and concern for the personal well-being of your workers. People who have other interests in other words and are able and are allowed to foster those alongside their their work that they that they do are often much more protected from burnout. So it's almost like instead of putting all of your eggs into the work basket you're putting some of your energy and passions into other things and it kind of has this protective effect for preventing burnout. So having a workplace that actually supports and promotes people's personal development in different ways can help to protect from burnout and develop a sense of loyalty and faith and trust in that organization. So facilitating whole person growth not just only work but also their whole life being mindful of personal interests and things like that. And then another one that I thought was very powerful if leaders show vulnerability they actually protect their workers from burnout and they actually will get more engagement and productivity from their workers. So if I as a leader in my clinic tell my staff you know you all are really smart. I don't know how to solve this problem. Do you have any ideas that you can bring forward that will create incredible trust for that worker who's being or that that manager or supervisor is being vulnerable to say they don't know something in other words. In other words asking for help can actually create trust for the for the management leadership of an organization OK. So now as we're translating this into what we can actually do to help combat or prevent burnout. There are some things that we do to cope with stress. These are some some reported things you know like more comfort foods exercise praying time with family friends and for the student population that reply. A lot of them sought counseling for example just to combat you know burnout and stress. I think to have a set of strategies to help your workers I think the first place to start is physical. So encouraging that person to get consistent quality sleep for example and try to really manage their sleep hygiene because if you can get good rest it often will help to lower your stress in general exercising daily. There's a lot of evidence now that there's incredible effects on mood and reducing depression symptoms and anxiety symptoms if you simply exercise. So moving your body you know every day can actually reduce depression by 50 percent. So it's pretty powerful just simply being active physically can help to kind of hope hopefully reduce some of the symptoms that somebody might be feeling general care self care healthy diet of course drink lots of water. People take supplements as well and there is some literature around that that's developing around groups of supplements called adaptogens for example which are those that are categorized to try to help your body combat stress for example. Of course if someone's showing signs of a medical condition they definitely need to seek care as you know anxiety depression etc. and or have any personal other personal health issues managing your personal health issues helps to reduce the stress on your body help will help to help make you know the work stress that you do go through more manageable and then also personal interests and volunteering. There's evidence that shows that it's a similar effect in your brain regarding oxytocin. People who have personal interests and or give to others it actually reduces work stress and burnout. So there's a protective effect related to that. So in in a manager's role or an organization enabling your workers to have time to do volunteering and have time to do giving and have programs for that can actually help your workers it helps to protect them. I think the next thing that we think about you know the initial is let's take care of our physical health and then of course there is usually some type of root cause around or causes around why somebody is developing you know symptoms for occupational burnout. I mentioned all of the many things that could be happening in this in the workplace to cause stress. These are probably the six most common or the ones you would think of the most. So workload. If somebody's workload is so overwhelming that it's not really they don't have capacity you're putting them at a risk for being burnt out especially if it's chronically high. So there are things you can do. One is resourcing. Try to get more staff to help. The other is try to optimize processes reduce take away the tasks that are unnecessary or producing low value and prioritize what are the most important things that worker needs to be doing and then streamline. Try to make their their life as easy as possible and take away the pain points that enables them to do their job faster and more efficiently. In other words control level. So we are talked about micromanagement identify ways for the worker that they can actually have some autonomy in their own job in the sphere of their own job be able to make some decisions as I mentioned according to the control demand model. If they have some control even though if their workload is high they're more protected from burnout. So try to find opportunities where your employees can actually make decisions where it's appropriate of course. Rewards. So if an employee doesn't feel rewarded they'll actually feel exploited in their work. So simple thank you is one way to reward an employee for a job well done. Verbal affirmation in other words. There are many other ways to recognize and create feelings of and create rewards for you know good work. Fairness of course I mentioned fairness is absolute or urgent and key. You can decimate a whole department if unfairness issues not being managed appropriately and urgently. Other employees need to know that there's a sense of fairness and justice in the workplace. And so if they perceive that that person's you know there's unfairness then it will affect everyone and it will be you know I think it's quite critical community. So developing a sense of community is important. We talked about the whole neuroscience of trust developing a community among the workers actually reduces the risk for burnout. So if people actually feel connected to their fellow employees in the job outside of work for example they actually will be more protected from burnout during times of high stress or high workload. They're more resilient and resistant to it. And then of course an obvious one probably but maybe many of us have actually experienced this at times. If you do a job or perform functions that are actually against your own values your own personal values that can actually be a high risk for burning out over time. So trying to alleviate that and figure out how to fix that is important. The next thing as a manager or in an organization you know whenever we talk about any kind of exposure one of the things you need to do is lower the risk of exposure. So take you know the person needs to be removed from the stressful situation. For one take their vacations as appropriate. Use their available leave. Have clear lines drawn around what's work time and what's not work time. We all experience email creep like I'm here at this conference having to manage my email because if I don't I'm going to have thousands when I get back and it's taking and take a long time to be painful. Probably not good for me to be doing that now on my Saturdays or my weekends or my vacations. There needs to be a clean line around what's my work time so that I have a have boundary lines around it and that I'm in a sense reducing the exposure risk to myself. So you can actually think of those six main risks or there could be others and then try to think of stress strategic ways to reduce the risk. We've kind of been mentioning them as we've been going along. Making changes to the work environment sometimes just having a new job or a new job task can help like having something new to do. So as a manager or an organization that can be something to think about if somebody is experiencing this type of occupational burnout you know once they've kind of calmed down and taken care of themselves physically taking their required rest and vacations simply trying a new tasks of things to learn. It takes away the mundane nature of work. Learning new things is actually really valuable and can reduce you know reduce that risk. And then of course the most extreme thing would be to evaluate a change of career position if none of those other things are possible. Of course if there's you know especially if there is a mental health component but I think in just in general getting support can actually produce resiliency and protection against burnout and other various conditions. Of course counseling I think can be a very effective way to help to process connecting with a mentor. I think it's very important. It's a it's a great way to reduce your stress if you can simply blow off steam with somebody that you trust who's going to keep a confidence. Just being able to talk about stress actually helps to lower it, lower it. You know, it's like you let the steam out of the teapot and then it's kind of easier to deal with after that. I think spending quality time with family and friends is ultra important. And I think the literature around friendship, for example, says that people who have even one close effective friendship can live eight years longer on average. You're protected from virtually every disease, including burnout, including depression and all the mental health conditions. So having friendship built into your life and making that a priority is actually a really important way to protect yourself, to protect your overall health and well-being and help and prevent burnout. So cultivating effective friendships is really important. We already talked about volunteering and giving can be another way to increase your brain oxytocin. So in kind of summarizing that all together, diversifying time is a way to help prevent burnout. So don't put all of your energy eggs into one basket. So people get very devoted to their jobs and that's good. But if our demands are so high that we have nothing else in our life, then we don't have any reserve to fall back on during those times of great stress. So do the things you want to do also, not just always what you should do, in other words. So I've gone through that fairly quickly. I thank you all. And if there's any questions, please feel free to come forward. Thank you so much. And I'm actually going to bring a lot of this information home to my little practice in OCMED and apply a lot of these. One thing I wanted to just share which kind of dovetails with your presentation was there's a lot of literature that is on the importance of mattering. And I think that dovetails with a lot of what you talked about. Every individual needs to feel like they matter. And I think all these concepts really help towards developing that. The other thing I also want to say, and maybe I'm overstepping, is that we need to work hard on just being nice. Doctors as a whole can often be not nice people to their underlings and it really negatively impacts them. We really need to watch our own shoes and work on that. It'll make a big difference. It'll make a difference to everybody. I think, in a way, our tanks are often at zero because we're pushing it to such an extreme all the time. And we're not doing a lot of these things to care for ourselves. It's hard to be nice if you have nothing to give, in other words. Yeah, it's true. So it's really important for us, too, as physicians to really be, and nurse practitioners and other providers, to really be caring for ourselves as well because then we can care for our employees and our patients better. In my little microcosm of my little clinic with my 12 to 13 workers, I work really hard on being very nice and sunshiny and all that. And I've noticed that, over the years, if I get really mad in the office at someone, it really blows up because I think they have huge reactions to it. So I'm always very careful about that. It just goes to the point that people are very sensitive. And I think we all have to keep that in mind. You have to really try hard. I agree. Thank you. That, I think, taps into the concept of trust and how important that is as well. Yeah. Yes? I think they're recording. So if you wouldn't mind. Yeah. Sorry. Thank you for a great talk. And I love your art, by the way. I think, thank you for reminding us what we need to do. I think what Susan told us, everything we learned, we learned in kindergarten. And I just want to say, please, thank you. And I'm sorry, I think, but we lose that in perspective. But I think a lot of what you're saying, I think, is you're preaching to the choir here. But what are your recommendations when you have an HR leader or a senior vice president coming to you? I'm like, what's going on? Why are my people this presenteeism, absenteeism, leaving, blah, blah, blah? When, frankly, they're the ones who are doing it. So what are your recommendations as to how? I think this would be a great talk to managers, to HR, to high executive leaders that put these, the pressure on. So I would love to be able to get your input on that. Yeah. I think that sometimes that can be challenging. I've been in corporate roles for many years. I would say we don't want to be pointing fingers or punitive. But I think if you simply share information, like, look, what I found, this knowledge base about how to build high-trust organizations, if we demonstrate these behaviors, that will actually improve our productivity and will reduce burnout. What do you all think of that? And then see kind of how they would engage with that in a way that's positive, that's not pointing fingers at negative behavior, but trying to call out to them what the data actually shows. Be science-based, in other words. I have had success in this, although I would say it's not always easy. I work in a tech company, and there are a lot of them who don't have people skills. So I'm frequently reminding, as they're getting very technical and into the process, and this person has a disability, and the lawyers are getting involved, and I have to stop everyone regularly and just remind them, you know, this is a human, so let's have compassion and empathy for this person first. That's really important. And then they're like, oh, oh, yeah, that's important. So I think we can continue to be the voice for having more care and empathy for our workers. Thank you. Yes, sir. All right. Thank you. This was quite a very good presentation. Thank you. But I just have a few things to ask. Okay. I think the first thing is, in most organizations, what you do find is that the managers are the ones that are doing the bullying. Yeah. And they don't want you to tell them that this is exactly what they are doing. Yeah. So when you say that, and HR gets involved, HR, they forget that they are supporting the managers as well as the employee. But what I've seen from my many years of experience is that HR is just on the side of the managers. Yeah. So when you point out to them that this is an issue, they are in denial, and they come up with all sorts of other reasons as to why the employee is stressed out. Yeah. And more importantly, when you do have meetings with employees, I mean, they doctor the notes or the conversations of the meeting, and you find out that they were all filled with lies. Now, I've been wondering. I've been a very senior physician for a long time, and I've been managing myself. I've not had any training where I've been told to tell lies when I have meetings with employees and so on. But this is a common practice that I've found in several organizations over time. Yeah. Now, you talked about the individual being able to control the things they do or choose to do, things that excite them. I think in most cases, in reality, they haven't got that choice. Yeah. Because you are in a job. They define what you've got to do and so on. And the difficult bit is what would you do when the managers are doing the bullying, are causing the problems, they are in denial, and then you do not have much support from HR. How can that be resolved? So, this is really interesting. A previous employer that I was at, this was a really big issue. And so, we actually kind of would laugh about it behind the scenes because we knew the disability rates for all the supervisors. We could actually list it by supervisor. And we knew those that had very low rates, they were the excellent supervisors, that nobody wanted to be away from work because they were afraid someone else was going to take their spot. So, in a way, it was like a way to measure indirectly who are the bullying difficult managers because they had high disability rates. And then we could actually... I think a relational approach works. So, building relationships with that manager, not trying to be punitive or point them out, but if you're in a relationship with someone, they're more likely to listen to you, for one. And if I had to give a hard piece of information to someone, any person, usually the rule I follow is I usually say three positives before I say a negative. So, I'll say, you know, you're a great manager. I can tell you work really hard. You care about your employees, but also this thing. Once you speak positives, people's ears are open to listen and be able to receive the criticism that you might be saying. I'd say that approach has worked for me many times. I would say it's not 100% because, you know, some people are just wired a certain way. I think, though, that we can make efforts to help educate, you know, how we design systems, for example, how we're training managers around some of these issues. Letting them know, you know, if this company or this organization has a high rate of mental health, you as a manager play a really important role, so you can speak it as a positive. Your interaction with that supervisor, with that employee to show care and concern can save this case. It can actually make them want to come back to work. And the manager's like, oh, I have that power? Yeah, you do. So, I think some of those strategies can work. And what was the other question that you asked after that one? I'm sorry. I think basically you've answered the question, most of the questions in a nutshell about the fact that educating managers and probably a positive feedback with a slight indirect negative swing as towards, you know, the cause of the problem for the employee. Yeah. Okay. Right. The other question was about the fact that the distortion of the meetings that HR managers have with employees. And unfortunately, I think the positions of most organizations is that they don't bother about the fact that lies are being told by HR managers in the notes that they've taken down, or in fact, in the subsequent notes that they've produced after the meetings that they've had. Yeah. Because what employee has said, or what the discussions were, were completely, totally distorted. And this is a very common practice among a lot of senior managers in organizations. So, I'm not too sure how this could be actually be addressed or resolved. It's probably a top to bottom type of culture that needs to change, probably. Yeah. Because, you know, the top people are pressuring downwards, and managers are pressuring their employees. So, it's probably a wide culture shift that needs to happen. So, that's a complex thing to do. It's not impossible, though. It can happen. Cultures can shift and change. Yeah. Okay. Thank you. I thought that was a really great presentation. And I had a question around graduated return to work for workers who have gone through burnout. I work in an occupational health clinic in a hospital setting where I see staff. So, I see quite a lot of clinicians with burnout. Yeah. One example is a young doctor working in the emergency department who has been off work now for probably about four months. And we're gradually getting her back to work. I mean, obviously, that environment is one where you have very little control over workload and extremely high workload. Right. Does that kind of timeframe of somebody being off work for several months before you gradually get them back to work? Yeah. I think work hardening can be effective. It's probably be really hard to jump that person from zero to 100 all of a sudden. Oh, yeah. There's no way I would be able to do that with her. They'd be back out again pretty fast. Yeah. So, I think you can develop really good, clear strategies for gradually returning someone and exposing them to that type of workload. If it's unchangeable, you can't redesign something easily so that they can be phased back in. I would say often I have found with businesses that I've worked with regarding accommodation, sometimes they're not willing to accommodate gradual return to works. So, that makes it a challenge. So, I have to try to communicate and advocate for the employee to say, this gradual is actually going to enable their success. Is there any way that you can try to accommodate that? And they do their best, but sometimes they just can't. I think I must be very lucky in my workplace then, because most of the managers are very willing to do graduated plans. So, that's helpful. Well, that's actually a sign of a good work culture, actually, where managers are supporting employees. So, then you can get to your causation. What is the root cause of that burnout? Probably it's truly like high levels of workload. So, maybe there's a resourcing issue. You could make a case for getting more staff, for example, et cetera. Great. Thank you. Thank you. Hi. Thank you for a great talk. I'm Jackie Moline. I'm from Northwell in New York. One of the things that the national numbers don't tell us, really, is sort of the age discrepancies in burnout. And I think, as we heard in a talk earlier, the average age of ACON members is 57. And our generation does not have the burnout that the younger generations have. And I think we need to consider the generational switches in terms of how willing they are to have work-life balance and what that's going to be pushed up against. Or they want the work-life integration, they demand it. So, we need to think about it in those contexts because the numbers are very different. The good news is the younger generations are more likely to seek out help than the older generations. But in any of the studies of burnout, a solitary number is not going to tell you the whole story. Correct. Yeah, I think that's a great call-out. Thank you. Hi. Hello. Great talk. I just have two quick questions somewhat related to each other. In a lens of workers' comp, it's come up lately at my organization. I'm in health care. What is the employer's responsibility pre-burnout in terms of maybe a psychological first-aid training, something to that effect? I had an executive ask recently, what is the mental health equivalent of a needle stick? And I really didn't have an answer for that. So, also in a post-burnout or burnout situation, when does that maybe fall into a workers' comp situation? I know that workers' comp laws vary so much state to state. And in the U.S., there's often an assumption of not work-related for mental health conditions. So you have to go through quite a proof causation that is directly linked to the workplace. So you'd have to build a case for that to be able to even be on workers' comp for a mental health issue. Part of that, I think, is I think in certain countries, they opened up the floodgates for mental health conditions and basically bankrupted the system really fast. So they had to keep those boundaries on. But I think that there are definitely times when mental health is connected to the workplace. You know, people experience traumas in the workplace, for example, and develop PTSD as a direct result. So I think you can assess all those things and try to make a case. But the workers' comp is, that's a, you know, it's a challenge. There's so many varying laws, every state, and also around the world, country by country as well. I think either way, you can still advocate for the employee, even if they don't get accepted under workers' comp. Thank you. Yes, sir. Thank you very much. Excellent presentation. So I have a comment and a suggestion also to learn about this even much more. We doctors, as you all agree, are very good at treating physical ailments. But when it comes to treating the mind, mental issues or something like burnout, that is we find that we are lacking skills, knowledge in doing that. So that is an area I think we need to improvise. So I suggest that if it's possible, we can have a workshop on this. You yourself pointed out that it's the top management going down to the bottom and they have to follow the culture and it's a complex situation. But that complex has to be simplified. And I think we can do it better if at Austin you have a workshop and we attend and maybe we learn some skills. Suggestion. Thank you. Thank you. Yeah, great. Any other questions? Yes, sir. Hey, Jerry. Hey. Is there ever a time that you would recommend a medication to help someone who's burning out? I mean, people turn, of course, to alcohol. They turn to marijuana. They turn to these other things. Is there ever a role for a medication to help them, even if it's temporary, to kind of get them back to stability? Yeah, I don't know that there's any published recommendations regarding specific medications. My guess is it would probably be more connected with their primary diagnosis. So if they meet the criteria for depression or anxiety, then you treat as appropriate. I also tried to give a feeling for other things as well that can help to reduce symptoms at more of a holistic level as well. So I think in terms of prevention and the four pillars of health, so socialization is very important. We all have to live in communities and be relating to each other. Having friends, it reduces burnout. So I tried to touch on a lot of the more holistic views. But, yes, I think pharmacy is, of course, appropriate at times, especially when there's diagnoses that are specific and can be treated. Thank you. All righty, thank you all. I hope you have a great rest of your week.

occupational burnout

workforce population

stressors in the workplace

acute and chronic stress

intervention strategies

workplace stress

mental health

trust and engagement

supportive work environment

gradual return to work