Transcription:
Addressing Burnout in Leadership Roles

Prakash: We've been hearing more and more about job burnout and what may cause it. So knowing what signs to look out for is important, especially if you're in a leadership role. We're going to talk about it today with Dr. Erick Messias, a professor of psychiatry at the UAMS College of Medicine and the Associate Dean for Faculty Affairs.

This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So first of all, Dr. Messias, it is great to have you here today. Let's start with the basics. What exactly is burnout?

Dr Erick Messias: It's good to be here as well. Burnout actually is a term that came from a novel by Graham Greene called A Burnt-Out Case. But then in the 1970s, was adopted by psychologists to describe what today we define as an experience in response to chronic job stressors. So that experience involves three components.

One is exhaustion, which is a physical response. The second is cynicism, which is a psychological response in which you don't believe in what you do anymore. And the third is a sense of inefficacy which basically means no matter how hard you work, you're never done with work. So when you combine these three factors, you are experiencing something we call burnout.

Prakash: Well, I have to say that I've never heard it broken down like that before, but it is extremely clear. So you said exhaustion, which is the physical component; cynicism, where you don't really believe in what you're doing anymore; and then finally, inefficacy where it feels like you just can't get everything done. Is that correct?

Dr Erick Messias: That's right.

Prakash: Okay. So what causes these three things to happen?

Dr Erick Messias: So work has changed tremendously in the last few decades, right? It's hard for people to believe, but, you know, those of us that worked 30 years ago remember when there was a time when not everybody had a cell phone. There wasn't a smartphone that could do emails and text message and social media all in one time.

So all the changes in the way we work in the last two decades have led to a situation in which the way our brain is structured is actually not working well with the way our work is structured. So changes in the workplace in the last decades have led to an incredible load of information and constant request for attention that the human brain just is having a really hard time adapting to it.

Prakash: Yeah, that makes a lot of sense. It seems like we live in this age where we are constantly tethered to our phone, which is an influx of work requests that just never seem to end. So I can completely understand that. That kind of leads me to my next question around what types of jobs or roles are the most likely to experience the burnout that we're talking about?

Dr Erick Messias: Well, ironically, it's those jobs that do deal the most with people. So if you are completely in the world of machines, things are a little bit easier actually. But if you are in the interface between the machines and the systems and work with customers, you have much higher risk of burnout.

So what are the professions that are in the frontline of customer service? One is people that deal with teaching, that deal with students, so teachers. The other is people, of course, in customer service that usually are dealing with customers that are not satisfied. And the third are healthcare workers. So in healthcare, we're dealing with people that are struggling through pain, illness or disease. So those professions in the frontline of care, first responders, such as police and firefighters, those groups of people have a much higher risk of burnout than, say, blue collar jobs and other professions.

Prakash: And is that just because they feel like they have to always be on and communicating with those people, whereas when you're working with machines, it's like you operate the machine and then you're done at the end of the day?

Dr Erick Messias: Right. So there are a couple of factors that play a role in this. One of them is actually job control. So when you're dealing with machines that are very predictable or work systems or work processes that are very predictable, you have a better sense of what's going to happen. If I do A, I'm going to have B and then get C.

When you're working with people, it's not like that. When you're working with people, there is a whole lot of uncertainty. And then you have changes in the way the workplace is organized in which the sense of job control is reduced. So for example, physicians today, as a physician, I experienced this first person, we have to be accountable to an electronic medical record system, which is always pushing more information for you and your job now became as much more complex. Not only that, you have access to those records all the time, 24/7. So your sense of job control is much diminished. Now, your job is controlled by your supervisor, who is checking your metrics, who is checking every single action that you do within a system.

Prakash: I see. So I kind of want to shift to different leadership styles and how that plays a role in burnout.

Dr Erick Messias: Oh, that's perfect. So different institutions in healthcare are creating frameworks to address burnout among healthcare workers. When I say different institutions, I'm talking about the American Medical Association. I'm talking about the Institute for Health Improvement. I'm talking about all the professional organizations for physicians. They're all trying to solve this problem.

Well, if you look at all the frameworks, they have one thing in common, is the role of leadership. So those in leadership are responsible for restructuring the jobs and restructuring the work processes. So there is now data coming from the Mayo Clinic that shows that leadership styles actually have a direct impact on your risk of burnout.

So leaders that can communicate better, leaders that can look for more democratic ways of decision-making, leaders that can share all the changes that are costly going on in the organization have been shown to decrease your risk of burnout compared to the old hierarchical command and control type of leadership structure.

Prakash: And why do you think that is? Why is it that kind of being more, I guess I'd say empathetic or sharing the responsibility of the things that are coming at you, why is that better than the old style?

Dr Erick Messias: Excellent. So one of the things that has happened with this changes that we talked about in the last few decades is that the sharing of information is much more common today than it used to be. So people today, they not only want to be informed, but they are informed. And if they are not informed, they can find that information much easier than in the past.

If that's the case, they want to be part of the decision-making process. So we are dealing today with a very different population than we dealt with two generations ago, right? So let's take an example from patient care. If I was taking care of a patient, I'm a psychiatrist. So if I was taking care of a patient with say OCD in the 1990s, the person will come to me, I will identify the symptoms of obsessive compulsive disorder. I will give the diagnosis and I'll provide some recommendation for treatment. Well, that's one thing 20 years ago.

If you look at how this is done today, most likely than not the patient's going to come to you already with a diagnostic hypothesis with a lot of information regarding the condition and with treatment options. So even the patient wants more participation in their decision-making regarding medication choices and treatment options. The same goes for workers, people that are working today have much more information and much more expectation to be involved in decision-making than people working generations ago.

So we need new leaders. We need leaders that can deal, that can work well with the new generation that is coming to the workplace, which has very different expectations than people that come into the workplace in the 1980s and 1990s. We are dealing with a different generation, different expectations in a different work environment.

Prakash: Yeah, I totally understand what you're saying. And I also feel like it's just so much burden for a leader to have this unilateral decision-making ability where they're not taking in the feedback of the people that they're working with. So the brunt of the responsibility falls on them, whether they make the right decision or not, which can cause just so much stress in their life, wouldn't you say?

Dr Erick Messias: That's an excellent point. So you're touching on the burnout for leaders. So there is actually evidence today that the time people stay in leadership actually is shorter today than it was a few generations ago. Because again, there are so many changes. So what we hope to create is a sustainable leadership model in which leaders can share more of the decision-making. They will be better leaders and they're going to have less burnout among the workers. So that's the model for 2020 forward.

Prakash: So whether you're in a leadership role or not, what are some of the actual things that people go through when they are experiencing burnout?

Dr Erick Messias: Right. So best way to answer that is to go back to those three components that we talked about before, right? The physical response of exhaustion, so a sense that you don't have any energy left at the end of the day. The psychological response of cynicism in which you really have a negative response perspective to your job, it's the job of other people, so you're always negative. And the third is a sense of inefficacy, which is no matter how hard I work, I'm never done. I'm never done.

So this has to do with two factors. One is the lack of boundaries between work and family personal life and the lack of limits between these two worlds. So we're going to have to find a way to integrate better our lives so that we can have the proper time for family, time for personal life and time for work. So you asked me what types of things people would feel or they can identify when they're in the process of becoming burnout, exhaustion, cynicism, inefficacy.

Prakash: Okay. Totally. So if there is someone that is in a leadership role that is starting to experience some of this, what recommendations might you have around trying to reverse it and get better?

Dr Erick Messias: There are resources out there and leaders, as well as anybody else in the workplace, should look for it. The first that I'm very keen on is fostering a sense of belonging and finding your peers. So sometimes when people find themselves in leadership positions, it can be very lonely, because you don't have a lot of peers anymore. So the advantage of our structures today is that you can find peers at the national level.

So I'll give you an example. as the Associate Dean for Faculty Affairs, I own board all the new chairs of our departments at UAMS. One of the things that I always advise them to do is find your peer group, because you are the only chair here on X department. There's no peer here for you, but you can find a peer at the national level among other chairs of similar departments across the nation. So I think finding your peer group can be very important and can actually help you create that sense of meaning in what you do because now you have somebody else that is going through similar challenges.

The second option that I think can be very helpful and there is data to show that it's helpful is finding an executive coach. So, as you said in the introduction, I'm a psychiatrist and I'm a therapist, but I've also done training and executive coaching. Coaching is an interesting set of skills that took tools from psychotherapy, from organizational development, from positive psychology and put them together in creating coaching conversations that can actually push people forward.

So several organizations today include in the package of their leaders an executive coach that can help them develop their full potential. So I do recommend executive coaching not only to professionals, but especially to leaders, because it can actually get them to continue developing, that they don't see that wherever they are is the end of their career. There is always place to grow personally and professionally.

Prakash: Yeah, that is really good advice. Now, you know, there's going to be people that are kind of stuck in this cycle of working and even if they feel these feelings of burnout, they just keep going. So can you maybe speak to what could potentially happen if they don't get help and do some of the things that you're mentioning?

Dr Erick Messias: So I would strongly to encourage people to get help because the other option is to find ways to cope with this that are not healthy in the short-term or long-term. What I mean by that is things like on the professional side, your productivity is going to decrease, your turnover is going to increase, your quality of your work is going to decrease and suffer.

On the personal side is even worse. You may develop a mental disorder. And I'm a psychiatrist, I'm very used to seeing people developing anxiety and depression and sometimes alcohol and other drugs become part of your solution. Those solutions may make you feel better on the short-term, but on the long-term you pay a huge price for it. And unfortunately, we see this even in severe depression as well as in suicide risk among professionals.

Prakash: Yeah, definitely don't want it to get to that point. So, you know, just as we start to close here, I know that you've probably seen many different patients that have gone through this, and I think that you've broken it down very well for us today. But if there is one piece of advice that you could leave people with given all of the experience that you have, what might that be?

Dr Erick Messias: Understand how you cope with stress. We all have coping skills. There are some coping skills that are helpful, say exercise or talking to your partner, somebody you trust. So find how you cope with stress. And if you find that the way you're coping with stress is not helpful in the long run, say overeating or drinking or becoming rude or unprofessional, fix it, work on it, because these things are not going to get better on their own. They're going to get worse.

So one thing I always emphasize is understand your coping skills and then shape them. That's my message.

Prakash: Well, Dr. Messias, I think that is a perfect place to end. Thank you so much for your time today and your very valuable insight. That's Dr. Erick Messias, a Professor of Psychiatry at the UAMS College of Medicine and the Associate Dean for Faculty affairs.

For more information on this topic and to access any resources mentioned, please visit UAMSHealth.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been another episode of UAMS Health Talk. Thanks and we'll talk next time.