LTC11: Sources & Tips to Manage Burnout

In this BSC podcast, Prof. Matt Andrews interviews Harry Fletcher-Wood, PhD student in Public Policy at King's College London. Harry discusses the sources of burnout and provides insights on how to try and reduce burnout during crisis situations.

Read our Public Leadership through Crisis blog series.

Transcript

Katya Gonzalez-Willette [00:00:04] Hello and welcome to Building State Capability at Harvard University's podcast series. In this BSC podcast, Professor Matt Andrews interviews Harry Fletcher-Wood, PhD student in public policy at King's College London. Harry discusses the sources of burnout and provides insights on how to try and reduce burnout during crisis situations.

Matt Andrews [00:00:26] I'm really glad to be here with Harry Fletcher-Wood and Harry is researching at the moment for PhD, if I'm correct on the topic of burnout. It's a topic that a lot of people have been interested in, when we think about running a crisis marathon as a sprint. And how do you manage burnout? And I think it's an even bigger issue when you think that people are not necessarily together, they're apart. A lot of the mechanisms you would usually use, maybe separate ourselves from work are not quite there anymore. So Harry thank you for being with us. And I wonder if we could start with you just describing what's your research about and what are you finding about burnout?

Harry Fletcher-Wood [00:01:02] Yes. So I'm a schoolteacher by background and then got into teacher development. And now for my doctorate, looking at various things, including how do we keep teachers going, which is a huge issue in UK schools where I'm from, we have high teacher turnover and high teacher movement between schools. And in the process you see teachers leaving the schools where they're needed most because that's where they're under the highest pressure often. But it's like a policy relevant question wherever and whenever you are. And so I've been looking into that. I started my doctoral research. And then with what's going on now, I've been looking into burnout among doctors and seeing what we can do about that as well. Keep going and rolling some of the highlights?

Matt Andrews [00:01:45] Yeah, give me some sense of what it is that you found. I think all of those contexts are kind of related because teachers who are in the hardest areas, you could almost call them the high stress areas. It's the same kind of stress that you're going to have in a crisis. It's people who experience that kind of thing every day. So what are you finding?

Harry Fletcher-Wood [00:02:00] So the key thing, I guess, is understanding what burnout is and where it comes from. And it's this idea that that burnout is the accumulation of stress. You can have a bad day. You can have a stressful day and life will go on. But if you are excessively stressed on an ongoing basis, well, at least to the kind of exhaustion and the exhaustion is both emotional and physical. So you get to a point where you don't feel you can do anything. You maybe feel like you can't drag yourself out of bed, or like continue with what you're doing. And once you've reached that point, that's not going to get better on its own, so you're probably going to need some kind of treatment. And when people have looked at this, they've found that people who are burnout are more likely to be absent, to take sickness leave, unsurprisingly, but also that it correlates with a whole load of things that we don't want. Among doctors, it correlates with medical errors, correlates with divorce. It correlates with job dissatisfaction and correlates with suicide. It appears to be highest in roles where you have to try and help people. So where you have this ideal that I'm going to be a great doctor and I'm going to look after everyone or a great teacher, and then the reality, whether that's coming from your organization, the impossibility of your dreams, gradually wears you down to a point where I can't do this. And not only can I not do this, but I'm betraying my patients, betraying myself or, you know, whatever it is.

Matt Andrews [00:03:23] That's very interesting. And it sounds like I mean, those are tragic situations to be in. And, you know, if you are in a difficult job and the job is difficult already and you hit that wall, it's not good for anybody. So I guess the key is not to burn out. Right. And the key is to, I guess, be able to identify, not even when it's happening, but to be able to identify: am I in the kind of job? Am I in the kind of situation where it could happen? And then what tools do I use to try and make sure I don't burn out? Is there a significant amount of thinking about how to do that? Both how to identify if I'm at risk of this and then also kind of what to do to make sure it doesn't happen?

Harry Fletcher-Wood [00:04:03] Yeah. So I'd say there's quite a lot about what the phenomenon is like loads of surveys that are pinpointing, like, what are the kind of predictors. And we're just getting to a point where we're starting to see good things being trialed that might push us in the right direction. So in terms of the predictors, if you're looking for yourself personally, if you're looking for your team or your organization, I think the key thing to think about is the balance between demands and resources. So demands, whether that be your workload, whether that be the fact that you work in a frustrating organization, whether that be role conflict, are things that cause stress and resources are things that ordinarily you just like make you like your job better. I'll talk a bit more about what some of those are in a second. But they also have the function of acting as a buffer. So if you're under heavy demand, if you've got good resources, you can deal with that demand better. So, like, it just really simple concrete example to say, like, okay, you're a doctor, you have an awful shift, everything goes wrong. If you're among a team of people who look out for you, support you at the right moment, you come away from the shift being like, I had a terrible shift, I can move on with life. Absent that, you come away from the shift and you're like, everything is awful.

Matt Andrews [00:05:14] Interesting. Interesting. It sounds like I mean, there's obviously what kind of work you do, how difficult the work is, but also how it's structured and how the relationships in your workplace are structured, maybe even how the entry and the exit from work. Things as practical as that, they can be used to affect what those demands look like and how you are handling them.

Harry Fletcher-Wood [00:05:32] One of the really counterintuitive things is that often the things that you would think are worst for professionals don't have a massive impact. So there's a French study of surgeons and they collected stuff like the hospital death rate and the kind of patients the hospital got in and none of those things were correlated with burnout among the surgeons.

Matt Andrews [00:05:51] Interesting.

Harry Fletcher-Wood [00:05:51] Likewise, there's a survey out in England of teachers that finds like hours worked, doesn't correlate with burnout. And it's the thing that like actually the pressure is probably OK. Again, if you're in a supportive environment, it's much more likely, the old adage that people come to organizations and they leave managers, like if your manager is unsupportive, that makes life an awful lot more difficult than particularly challenges that are intrinsic to the role. And that's not to say that we should ignore the fact that deaths on a ward are going to have a big impact on surgeons. But focusing on where the real pressure is and what the issue is. So among the surgeon, the things that were predictive were things like how many nights just they done and whether they rested properly recently. So yeah, understanding that the workplace organization, the workload that you're under, like the environment that you're working in, is really crucial. And the first thing that you can do if you're trying to prevent burnout is just to find what those stressors are and, if you can, reorganize around them.

Matt Andrews [00:06:49] It is interesting and it is counterintuitive, but I think actually to an email that I read yesterday from one of my kid's teachers who said, "I have three kids at home, they all under five. I'm sitting at home right now with them. My husband and I, we work with the kids until four, five, six p.m. That's all we do. They're at that age where you can't leave them for a minute. Then we have dinner together. Then I start grading. And she literally said I grade until 3:00 in the morning." But she also made the comment, "I'm just loving it." She was like, "I'm loving every second of it." So to your point it's it's almost like kind of like I love kids. I love being with my kids. I get to be with my kids. I get to determine when I do the work. I'm working unbelievably hard. But you know what? That isn't a problem to me. And it and it is counterintuitive because you'd think things don't work like that. But I guess she's choosing when she works. She's choosing what she prioritizes. She's choosing kind of, you know, when she moves in and out of roles and maybe in other parts of the day when you're not working those kinds of hours, but you don't get to make some of those choices, you could actually experience more stress because you don't have more control over your time. Is that the kind of thing that you're saying?

Harry Fletcher-Wood [00:07:56] Well, what I love about that, you've hit on about half of the different resources that the researchers would point to, just in that short story. It's things like if you find your role meaningful, clearly that's going to keep you going for longer. If you've got more control over it, which you're saying that she has, if you're around people who you want to be around, all of those things really make what would otherwise be a stressful situation or what is a stressful situation, bearable.

Matt Andrews [00:08:20] So Harry, it sounds like the job of being a leader or a manager is absolutely crucial in this. So if we are speaking to people who are now in this COVID-19 situation, let's say firstly the people who are managing or leading frontline workers, you know, these are people who have to go into a hospital or people who have to go into a grocery store or whatever. When they're going to work they do have to think in the back of their minds, "I may get sick today, etc. or maybe I have to leave a sick person at home..." Or whatever that may be. How would you be thinking about, for frontline workers, leaders or managers structuring their work arrangements or structuring their relationships or whatever to help to minimize that stress and ensure that there isn't burnout? Because the situation is going to go on for a good while.

Harry Fletcher-Wood [00:09:05] Yeah. One question to ask yourself is, are there ways that I can reorganize things to reduce these stresses on people? And often it's you know can be quite simple things like how you structure shifts, or how you structure rest breaks. The maximum we're hearing, for example, about medical staff like it takes ages to get in and out of your protective equipment so you barely even get to go to the bathroom or get to like go and have a cup of tea or whatever it is. So looking at like if you're in that concrete situation, is there a way that you can give people double the length of break, but half the time in order to make sure that they actually get the chance to sit down rather than just, you know, keep going through it? So apply it to that like, how can you reorganize? I think the single most important thing is understanding the stresses that people are under. And I think one thing that keeps, a light bulb that keeps going off for me is just something simple, like a pulse survey that we see quite often in offices, but maybe less often in non-office environments, like literally just send your people maybe it's a one question Google Form once a week. And the question is just like, what is the most annoying thing that's going on for you? Or like, what is one thing we could do that would make your life better? I think people will, almost everyone will almost always tell you what things are frustrating to them or what they're really upset about. But too often they don't get asked. And so they just go along bubbling with it and then they like mention it to colleagues, but it never gets up to top management. You know, walk around if you can. Obviously, there's controls on that, but keep asking people at every opportunity what can we do more for you? And then tied to that is keeping people really informed. Again, like, if you're not able to restructure the shift or whatever it is around what people need. Just if you explain to people why that is, just being well-informed and making sure that people are getting feedback about what's going on, I think it's incredibly powerful.

Matt Andrews [00:10:53] One of the things that I'm thinking about also as you're talking, is just and I never really thought about is how a workplace conflict between people and it might be a cause of burnout and lead to extra demands. Is it the case that is an issue that, you know, the amount of time and energy and perhaps tension people go through when they are in a bad relationship with someone at work or when they have to argue over resources or whatever it is, does that lead to burnout? And would it behoove leaders in this time in particular to be keeping a very close watch on the relationships of the people in the organizations and trying to manage the differences between people so that the people don't have to manage them on their own?

Harry Fletcher-Wood [00:11:36] I would definitely say that's going to be an issue. And we know like one of the best predictors of whether people are happy at work is whether they say they have a good friend at work. And so you can imagine the corollary and also my people are just under a lot of pressure so it's a lot easier to make mistakes, to get frustrated about those mistakes. But yeah, being on top of that and reminding your teams of, like, organizational values or like this is how we deal with conflict. This is how we work it through is gonna be crucial at the moment. Even more crucial than normal.

Matt Andrews [00:12:03] So even better than having a leader who actually kind of engages in those things would be a leader or a leadership environment that sets norms and sets norms that people really stick to.

Harry Fletcher-Wood [00:12:14] Yeah, so I'd say norms. And I'd say habit and organizational rituals and routines. To say like this is something awful happens within our team, we have a thing that we always do and therefore we do it even when we're under the utmost pressure. So what is the thing that gives the norms bite that makes sure they happen when you're exhausted and you want to forget about it?

Matt Andrews [00:12:34] Do you have any examples of norms that people are using right now that are interesting?

Harry Fletcher-Wood [00:12:38] I don't have any that I know people for sure are using now. But I think anything, for example, that like. Well, I mean, checklists are really interesting. Anything that causes you to pause and review whether or not you are doing the right thing before you dove into a specific set of actions is going to be really powerful. And, you know, a checklist can be applied to to anything, it can be applied to a routine task. It can be applied to a situation that you're going to have to address. And the lovely thing Atul Gawande says when he writes about this is like it doesn't tell a professional how to do their job, but it reminds them what to do under pressure. This is why pilots, for example, use checklists so much.

Matt Andrews [00:13:13] Interesting. Interesting. And it establishes those pauses. It establishes, I guess, a little bit of a tempo around the work as well, which allows you to have those moments of reflection. You know, one of the things that as you're talking about and I think that you mentioned this on our call a couple of weeks ago, is in some of the emergency rooms when patients are being discharged, having, you know, gotten through this, they're celebrating them. And I've been watching on the TV, I saw in Beverly Hospital in Boston, they now play the song Happy whenever someone is there and they release balloons. Is that the kind of thing that leaders should be putting in place? Because it can maybe give people those moments of inspiration and those moments of almost levity, I guess, in this situation?

Harry Fletcher-Wood [00:13:56] Yes and no. And things like that are incredibly powerful because it's reinforcing your team culture. This is who we are. It's kind of reminding you of your sense of meaning, the fact that you're making progress. You're not just losing. The only tricky thing is like it's more like it has to grow from a team. If management say, "Ah we're going to do this thing." It just becomes a thing. You may have seen our health minister in the U.K. said, "Social carers who don't get the same love that our health care professionals are getting are going to have a little pinbadge saying they're a carer." Which is kind of a nice idea. You can see the merit in it, but it just fell absolutely flat. I want to you just pay them more and so on. So I'd say if you're a manager, see if you can find a thing and amplify it. Don't necessarily try and create it yourself.

Matt Andrews [00:14:38] It sounds like it almost needs to be something that is organic and genuine about it.

Harry Fletcher-Wood [00:14:42] Yeah.

Matt Andrews [00:14:43] And maybe you don't want to be kind of constructing something if someone comes up with an idea, really go with that idea. But let it be theirs as well and let it be something that is celebrated in your group.

Harry Fletcher-Wood [00:14:53] One of the things that keeps coming up in this stuff I'm reading is like people want to feel supported. They want to feel the support's there, but they don't want to feel that they need it. So if you can put in those things invisibly. So another example that a colleague of mine is working on is like, if you're a patient and you get discharged, what if we could just staple a little postcard to your discharge papers which invited you to write back like thank you to the doctors and the nurses. But as a manager, that's something you can put in place. But the message is very clearly coming from people who are the ones who you really care about as a practitioner. So put things in place rather than feeling everything has to come top-down.

Matt Andrews [00:15:30] Interesting. Interesting. One last question to ask is, you know, we're.now in most countries, I guess, a months, month plus into this process. Just before we started recording, I was mentioning that I can see that quite a few people are really starting to slow down in their work. And I'm concerned that maybe it's the signs of burnout either happening or actually having already taking place. Are there any ideas for people who maybe have not got to the point where they've actually hit the wall and now they need, you know, real help, but where they can feel that their productivity is declining. They don't really want to get on Zoom calls. They don't really want to engage. They almost just want to kind of keep away from it. They feel that they're not doing a good job. I guess these are signs of burnout. If you're having those signs of burnout, are there things that you can do to almost stop the process and recover some of the energy so that, you know, you don't hit that wall?

Harry Fletcher-Wood [00:16:22] Two thoughts on this. One, definitely, there are - mindfulness, for example, it's something that some trials among medical professionals seem suggest seems to work as looking at some beautiful photos of a nurse who had gone off shift yesterday and she's sitting on her phone. And that is not the thing you need to be doing at the end of an awful day don't check up on the news, message your friends but then like, do something nice. And we know that burnout correlates often with coping strategies so the people who are... and it's hard to tell what the direction is. The people are still making trying to like see their friends. I had a medical professional in the study I'm doing at the moment say, "Oh, you know, I did a quiz with my adult children who are now at home with me and I just did it like an audio pilates session, which my normal teacher sent me. And both of those were amazing for me." I think the flip side of that is like the people who need this most are not the people who are going to realize this under pressure, but actually, the key thing that everyone can do is look out for your friends, your colleagues, your relatives, and be quite forceful with them. With a, like, "You need to stop, you need to go home." And maybe work through the planning stuff we know works to say like, okay, what's the thing you're gonna do that's gonna be nice? Put the calendar invite now to catch up with your best friend. Don't just assume that you'll go home. And because I think people forget when they need to do that most.

Matt Andrews [00:17:38] Yeah. That's a good idea. That's a good idea. I like also, you know, one thing, even as I takeaway is thinking about how I get in and out of work situations, right. And I'm usually late getting on to any work engagement and I usually finish it late and then late on to the next one. And I know I would say that possibly is one of the biggest causes of stress for me. So, you know, maybe even there a practical thing would be force yourself to do fewer things, maybe give yourself some bigger buffers, maybe make sure that between Zoom calls, you actually go and get a cup of tea and take a look outside and maybe it means one or two less calls a day, but just maintenance of some composure in that period of time. It sounds like very practical ideas are accessible to folks, but you need to make sure that you're doing them.

Harry Fletcher-Wood [00:18:24] Yeah. Cam Newport's got this lovely idea in his book about, like, getting to the end of the day and just like write a note for the things that each day tomorrow so it's not like bugging you and then like get to a point where you're like, "Okay. I've stopped and I'm not going to look at any more emails." And I think that is really powerful.

Matt Andrews [00:18:38] It's great. It's great. One of my colleagues used to be a very senior official in the US government. And whilst she was on a call last week with us and she said someone said to her, can you do this tonight? And her answer was, "No, I watch bad TV in the night now. That's all I do, I binge watch bad TV." And, you know, this is literally someone who used to be kind of running significant parts of the world. And she said, "I'm just so exhausted by five o'clock that that's the only way that I can kind of maintain my composure for the next day." So, Harry, thank you very much for your time. This has been really interesting. Thanks for joining us on Fridays. It is one of the things that I actually think is amazing about, you know, the new reality is I do find people are reaching out and finding new communities. And it's great to have you in our community and thank you for your commitment to teaching, for your commitment to thinking about people who are burning out, because that is an important thing. And please let's keep in touch. Let's see if we can do this again sometime soon.

Harry Fletcher-Wood [00:19:29] Thanks very much, Matt.

Katya Gonzalez-Willette [00:19:32] To learn more about the Building State Capability program's, Public Leadership through Crisis blog series, visit www.bsc.cid.harvard.edu/public-leadership-through-crisis. Thank you for listening.