Host Intro (Gene Kim)

Our next speaker is Dr. Christina Maslach. She is Professor Emerita of Psychology and the Healthy Workplaces Center at the University of California, Berkeley. Her research focuses on burnout and job stress, as well as the positive antithesis of burnout, which is workplace engagement as a better framework for developing interventions. Some of you may have seen the incredible press that this topic has had recently, because the World Health Organization has recently declared burnout as officially a workplace condition. This is based on the lifetime of research of Dr. Maslach, and has raised the visibility of this topic to the highest levels of the organization and even corporate boards, especially in the fields like healthcare, as indicated in this New York Times article here. I want to thank Dr. Maslach for a lifetime of amazing work, and I want to thank John Willis on our program committee for introducing her work to me. We're living in an age where workplace engagement, as you heard earlier from Joe Aho, CFO of Compuware, about how important engagement is for the success of any organization. It is a board-level topic, and here's a way for us to attach our goals and aspirations to those directives. We know this is a better way. So I'm so excited that Dr. Maslach will be presenting her work for you today. Come on out, Dr. Maslach.

Dr. Christina Maslach

01Opening: burnout, climate, and colleagues

Thank you. Okay, now for something entirely different. No code, but we're going to talk about climate, and we're going to talk about colleagues, and what it is that leads all of this to burnout. And want to share with you what we understand about burnout up to this point, and hope that'll be helpful as you move through and do other kinds of things. So I've been working on burnout, and many colleagues of mine have also been doing this for several decades now. And we started with healthcare and human services. And healthcare continues to be a place where we see a lot of issues around burnout, but human services of all kinds, including ministry, including all sorts of ways in which people try and help, cure, teach, assist other people in some ways. Social activism also is another area where we've seen a lot of it. More recently, though, we're seeing some changes, hearing a lot more from tech industries, hearing a lot more from customer service industries than we did before. And what we're seeing is a similar kind of pattern. Obviously, some unique differences, but an important pattern. So what are some of the things that we've learned about what is happening with burnout today?

02The changing workplace

One is that the workplace, and it is a workplace phenomenon, it has changed. It's not what people used to be doing. The workplace was a very different kind of environment 40, 50, 60 more years ago. And here are some of the things that are actually changing that environment and making things like stress and burnout a little bit more of a risk. So we see fewer full-time careers. I'm a full-time career as a professor in a university, and I'm feeling like a dinosaur these days. There's not many people. You start the job and then you end it and retire. So multiple jobs, leaving, going different places. What I am seeing, and this is one of the themes that I'm going to emphasize, is a lot of it has to do with people in their workplace environment. And what we're seeing is less concern and commitment for employees in terms of taking care of them, giving them appropriate benefits, making it a job that you can have and still have a life beyond that. We're seeing a lot more destructive competition between coworkers. When I say destructive, it's the kind of throwing the other person under the bus so they won't be a threat to you when you come to promotion time. And what this is creating is a climate of fear in a lot of workplaces where people are afraid to speak out. They're afraid to confide in someone because they really don't know who's their friend, who will treat this confidentially, will help out as opposed to becoming their worst enemy. There's a lot more tactics being used that reward "talent," but not everyone. So there's, again, this more sort of destructive competition. People talking about getting shut out of opportunities after not a long time, and it's kind of like at some point, you're going to be deadwood, and this is it, and this is not going to change. And this is going to be your life unless you can find something else. And also very concerning to me is a feeling that the common good, that what we're trying to do, whatever kind of industry or occupation we're in, is to benefit the larger society, the larger world. There's a common good that we practice that we're also all about as a core value. So it's more about me than it is about we, and that changes, again, the dynamics of how people are working together in the workplace.

03The burnout shop as a business model

So the model that we're seeing more and more of, I remember seeing back in Silicon Valley, just down the road from where I live, back in the '60s, early '70s, and it's called the burnout shop. This was not the first time that I heard about burnout, but it was used, and I think actually my dad was an engineer and working in a lot of stuff having to do with the space program. And I remember burnout, as a word, probably came from engineering in some ways. We talked about he was doing work with NASA, so there was things about the rocket boosters that burn out as you're carrying things into space. Ball bearings burn out. And why? Because they're in an abrasive environment, and they don't have adequate resource, in this case, oil. So there's a lot of things there that sort of suggest to me that this is maybe where the origin of the term came from, but we're not absolutely sure. Any rate, what is the burnout shop? It was, at that time, a short-term startup. And basically, people were advertising, "We're a burnout shop. We only want type-A plus plus plus people. We are going to work you to death for a couple years, 24/7. That's our motto. And when you burn out, and you will, and have nothing left to give and nothing more you can do, you're going to leave. And we'll get somebody else, or maybe at that point, we'll have enough stock options, you'll be happy, we'll be happy." It was a kind of a model which was for short-term. It was a self-sacrifice model. It was something that was only supposed to be for a short time. But what we're seeing more and more is that kind of model of self-sacrifice for the rest of your life is becoming the model for the marathon, the long-term jobs, not the short-term. Lot of these places collect data. They collect big data, and they say, "We're looking at all kinds of things." They tend not to collect big data on the human costs of this. And I've listed a few of them up there that researchers like me and other people do keep track of. And there are human costs that come with this. Stress, health problems, physical exhaustion, sleep deprivation, a major thing. Disruptions of personal life. You're becoming this couch potato, and you really don't have great relationships, and your family isn't working out, and you really don't want to do things with people, and all the rest of it. A loss of your own sense of, "I'm doing something good and I'm feeling good about it," feeling good about the achievements. Burnout. But sometimes they can also go to much more serious mental health issues like depression, like anxiety, and we're also seeing it linked in possibly to suicide. And certainly in tech, we've been seeing and hearing about a lot more, particularly at younger ages, on this. Now, it's interesting because when I used to talk to people who were running different kind of organizations and sort of trying to say, "I've been interviewing people, and we're finding out more about burnout." And I remember once, early on, running into a CEO who said, "Oh, I think burnout's great. That's a really wonderful thing." And I was going, "Okay, and why do you think that?" And he said, "Well, if they burn out, it must mean they're not good enough, not strong enough. They can't take it, right? So this is not a good person, not somebody I want to hang on to. But if they burn out, they'll quit. I don't have to go through the process of firing them. So I think it's a good thing." This was a little interesting concept to me at that point, but any rate, this is how they felt about it.

04Unhealthy jobs and their costs

So we're talking about unhealthy jobs, unhealthy workplaces for people who are supposed to thrive and do their best and be innovative and break rules and all the rest of it. Okay. So the problem that we have a lot is a problem of unhealthy jobs, unhealthy workplace. And this is not news. This has been known for a very, very long time. And what have we known? Well, we know that there are certain kinds of job conditions that are highly stressful and toxic for human beings. And I'm just listing a few. Long working hours, high demands, insecurity, lack of control, low social support among the people you work with, work-family conflict, and there's more. But data has been collected on this for years, decades. This is not news. We know this. What else do we know? We know that these job conditions, these kinds of stressors, pose a danger to people, to human beings. It has negative effects, can have negative effects on their overall well-being. So what are some of the metrics for that? Increase in annual unnecessary deaths and healthcare costs, lower worker life expectancy, more working hours lost, greater risk of burnout, depression, and more. Lot of data on that. And what also happens is that when people begin to have these kind of problems, it shows up at work. They are absent. They're out on sick leave. They turn over more quickly. They quit. They make mistakes and errors, sometimes very major ones. They are not doing high-quality work, not checking, and so forth. So there's a lot of evidence of all of that. And it turns out there's actually a lot of evidence that these job conditions, no matter how much they are justified, we have to do it this way. There's not a lot of good evidence that they actually contribute and ensure productivity, all the errors, the problems, et cetera, or the bottom line economically. The estimates of how much stress, and burnout is a stress phenomenon, how much this costs, the latest estimates are $200 to $300 billion in terms of productivity losses, absenteeism, turnover, sick leave, all of these kinds of things. So it is a major problem. It's a major problem. It's not new. It's known. And if you really want to look at more of the data on all of this, I recommend a book that came out last year from the business school at Stanford called "Dying for a Paycheck: How Modern Management Harms Employee Health and Company Performance." So, this is something that is well-known. Why are we still having these kinds of problems? The mantra that I'm hearing from a lot of people when I go and meet them and interview them in different workplaces is what they're hearing. "Sorry, but we have to do more with less." And what I think we're seeing more and more is that that's the kind of mantra of the burnout shop. We expect more from you. You're going to have to work longer. You're going to have to work harder.

05Job-person fit in six areas

You're going to have to take on more responsibility. And these are the six we've found so far. Maybe there'll be more later. But these are the ones that will predict burnout down the road, or if it's looking good, is going to predict greater engagement in the future down the road. They are not in order of importance. They're probably in order of how much people think about them and recognize them. So everyone thinks first of all of workload. Too much, not enough, a lot of demands, not enough resources, all of that kind of thing. And that is a factor. It leads to the exhaustion of stress and burnout, but sometimes it's not the most important one. These other five sometimes are more so. The second one has to do with control. How much autonomy, how much say, how much choice, how much wiggle room you have in terms of doing a good job, coming up with new things or whatever, or are you boxed in, locked in, and can't make those kinds of decisions? Third area has to do with reward, and it turns out from the data that it's not so much about tangible rewards like salary or bonuses or perks. It turns out what's even more important is that you're getting social rewards, recognition that somebody, a lot of people, one person, whatever, notices what you're doing and lets you know that they thought that was pretty cool, or we should do more of it, or that was a great idea, or thank you for being there and really saving us on this one. So that social recognition is coming out very important. Community refers to the workplace community. These are the people that you come in contact with on a regular basis. So it's your colleagues, people you supervise, bosses, vendors, clients, whatever those kind of people are in terms of the work you do. And what happens here is, do you have an

06Burnout as a three-dimensional stress phenomenon

environment in which there is good support, ability to work together, figure out how to do things, you can count on people, they can count on you, or do you have something that increasingly people describe to me as socially toxic environment? I like what I have to do. I can't stand being with these people in my unit and team because they are... And they'll go off on the list. So when that community begins to go south in terms of negative kinds of things, fear, really bullying, bad kinds of interchanges and so forth, turns out to be really predictive of problems in the future. Fairness. This one hasn't been looked at as much, but it turns out it's sometimes really, really important, and that is whatever our policies are, whatever our procedures, whatever our practices are in our organization, in where we work, are they fairly administered? Are the people who're doing certain things the ones who get promoted or get the new opportunity or whatever it happens to be? Or are there other things going on? Depends who you know rather than what you do. And finally, values. And this is really what gives meaning to a lot of the work we do, and feeling like this is worthwhile, it's making a difference, I really believe in this, I have some passion for it, kind of thing that'll keep you going through all kinds of bad times, tough times, and so forth. And so is that happening in the workplace, or are there value conflicts and ethical issues? So these are the six areas where we find that, again, if there's one or more of these areas that have problems in a negative way, we see with longitudinal research, greater burnout risk down the road. And what does that look like in terms of mismatch? Well, here's one possibility. You get a demand overload. The imbalance is that there's way too much to do, cannot be done because you have not the resources, you don't have the time, you don't have the other people, you don't have the tools enough to be able to get it done and do it well.There's a lack of control. You are tied in and boxed in, tied down in terms of how you can go about and do the work, the best job you can. Insufficient reward. This is one that we see a lot, meaning basically that you do a good job, nothing happens, ever. I've asked a lot of people to describe a good day at work. And particularly in healthcare, for example, a good day is when nothing bad happens. There's no positive thing that occurs. It's the absence of bad stuff. No screamers. No all kinds of other things going on. And working in that kind of environment where the best you can hope for is that nobody will complain and there won't be a crisis or a problem is a difficult place to keep working in on the long-term. Breakdown of community. Oops, went too fast. But the breakdown of community is really problems with the working relationships that you have with all these other people on the job. And when we've got that socially toxic environment, you can't trust people, you're always fighting, there's bullying going on, there's all kinds of difficult stuff. Big predictor of burnout. Absence of fairness. This can really cause a lot of problems when people feel this is where discrimination lives, where glass ceilings are, where it's not being fairly done in terms of this. And this leads to a real erosion of values and commitment, and so forth. And finally, value conflicts. You're put in a position where you're doing something you think is wrong, it's unethical.

07Measuring burnout with the MBI

You're practicing one thing, but it's being preached something else, and you're really being caught in the middle of this. So when we see more of these mismatches, we see more burnout. We don't know yet from the research if some of these are more important than others. There may be individual differences in some ways. So there's still a lot more to learn about this. Okay. So burnout as a stress phenomenon. What is it? And, as Gene said, just a month ago, maybe a couple of weeks ago, the World Health Organization has recognized burnout as a legitimate occupational phenomenon, and given it a code and everything in the next ICD, which is the International Classification of Diseases. But it is not a disease. And the World Health Organization said that. How many of you saw any articles coming out about burnout is now a disease and your doctor can diagnose you? Anybody saw that, like in "The Times" and stuff like that? NPR, whatever. They got it wrong. They didn't read what WHO said, World Health Organization. It said it's not a disease. It's something that can lead to other kinds of health issues and can lead people to go to health institutions for help. So it's talking about stress. And they defined it exactly as I've been defining it right here. They defined it as a response, an occupational phenomenon, as a response to chronic stressors in the workplace, okay? Which they said have not been managed successfully. And then they say, and it's characterized by three dimensions, and here are the three. The exhaustion, this is the classic physical stress response. But it's not exhaustion alone. There has this negative take this job and shove it attitude, the cynicism, the socially toxic workplace, don't really like what I'm doing, like the kind of work I can do, but it's not great here. And the third one is a negative response, not to the job, but to oneself. And so the professional inefficacy, it's interesting how often it comes up in interviews, that people talk about the erosion of my soul, that I don't have a future. Maybe I'm not good at this. Maybe I've made a huge mistake going into the kind of work that I'm doing. So we see all three of those together intertwined as the burnout phenomenon. It is not a disease, although some people have said that. It'll be news to doctors who are often talking about burnout themselves, that they are the ones going to diagnose this. But no, this is not what WHO said. It said it's not a medical condition, but it is this kind of a stress phenomenon in the workplace. So it's been interesting. Yesterday, a number of you were coming up to me, if you recognized me at all or saw my name tag or something, and said, "I've taken your measure on burnout." And my response is, "Okay. What did you learn? What happened as a result of that?" So the MBI, the Maslach Burnout Inventory is the measure. It's a research measure, which I developed years ago, to do the work on burnout. It assesses the three dimensions of exhaustion, cynicism, inefficacy. It doesn't ask if you agree. It asks how often do you feel this way? And there's several different points that we ask.And each of those scores are looked at separately, because if you add them, you can get the same total with different combinations. But the point is looking at those, you can get different patterns, different profiles. And we've been looking at what is predictive of those profiles, what are the outcomes, what might make a difference. A lot of people wish it wasn't so complicated and want it to be one thing, like only exhaustion, and have one score and not three. But sorry, folks, this is what a lot of the evidence suggests we need to do it. So I have to say, I'm really pleased that the World Health Organization agreed with all that evidence, and that's what we've got now.

08Five profiles of work experience

Okay. So what are those profiles? What do we find when we look at the scores on the MBI and other things? Well, we basically find at least five different patterns. One is the burnout score, and you've got three high negative scores, high on exhaustion, high on cynicism, high on the inefficacy. Okay? But there's also disengaged, and this is where people only have one high negative score. The others are moderate or low, something like that, and they're just high on cynicism. That's the one that's coming out. We call them disengaged. We then have people who are showing only one high negative score on exhaustion alone, and that we call overextended. We then get people who have one high negative score. It's only on inefficacy. And these are people who, they're okay with the exhaustion, they're okay with the cynicism. They're not showing that, but they are showing negative self-evaluation. And then finally, we get a pattern where all three are not negative. They're positive, and we call that engagement. So these are the five profiles that come out, and what we're finding is that they show different patterns in terms of how they deal with work, how they respond to changes, and so forth. So here's some recent data. This is all physicians, in this case, and we're showing the five profiles. We're showing the six areas of work life that I talked to you about, plus one more because they insisted that we ask them some questions about administration and how they felt about it, and that's the little green one. But as you look at the profiles, you can see that on the far left, this is the engaged group. They are looking way better than most doctors. That's a baseline for physicians. So they're looking better than average, and you're seeing burnout on the right side, and they are looking very bad on everything, those six areas. But look at the three in the middle, because we don't talk about those as much or people haven't paid attention as much. But the one that's right in the middle, overextended, is the high exhaustion group. That's all. They have high exhaustion. They have one big issue and it's workload. That big blue line, big imbalance between demands and resources on that. But for people who think burnout is only exhaustion, and there are some who do, it doesn't look like the burnout profile. It looks different, and what you would do for people who are showing that kind of profile would be different than if you were trying to make a more positive difference with people in a full burnout mode. Disengaged, this is the high cynicism group, and they're beginning to show a similar pattern to burnout, which sort of suggests, and there's other data to support it, that when it's that negative, hostile, cynical kind of response, that may be a more important marker than the exhaustion. And one of the reasons I think that is because when people really begin to develop that kind of cynicism, they change the way they're doing their work. So instead of trying to do their very best, they're trying to do the bare minimum. What is the least I can do, get out of here, still get a paycheck? It's a very different attitude and a very different style of doing the kind of work, and is related to a lot of the things that we see.

09Burnout as a warning sign

So burnout is like canary in the coal mine, and when I say that, it's because when you put a canary in the coal mine, what happens? If the canary has trouble breathing, doing anything, then it's not going to survive in that environment. What are you supposed to do when it leaves? It's a warning sign of a toxic work environment, and what you do or should be doing is focusing on making the environment less toxic. But instead, what we're doing with burnout, even though it's a sign of a toxic environment, people are often trying to make the canary stronger and tougher and resilient. You can take any fumes in this environment if you're just strong enough, et cetera. This is not the way to solve the problem of burnout. We got to really be fitting people to the job. Training and education is one way we do that and make that better fit. We develop skills, practical experience. We teach people how to cope with stressors, also good. Although one of them, the best ways to cope with work is to get away from it, which begs the question of what's going wrong with the job? They don't help make the job less toxic.

10Fitting the job to people

I think fitting the job to people is really the way to go. We modify the work conditions that create negative outcomes. Using ergonomics. We've been doing this for a long time, nothing new. The physical environment. We do better designs for assembly lines, for seating, for whatever. I've had graduate students working on pilot cockpits so people don't make a mistake and hit the wrong button or pull the wrong lever. We can do that with the social and psychological environment as well. So what we have found is, if we look at psychological needs, what make people tick, what makes them motivated, what makes them committed and innovative and so forth, and there are seven of them, you can see up there. Autonomy, belongingness, competence, having positive feelings and emotions at times, psychological safety, fairness, and meaning. All of these, a lot of evidence show that if jobs promote those kinds of things, you get a healthier workplace. So if we go back to those six areas, let's say, how would it look like? Sustainable workload, having choice and control over what you do, getting appropriate recognition and reward, having a supportive work community. Doesn't mean you always agree, but you figure out how to work together to solve problems and move on. Fairness, respect social justice. What are the kinds of things that make that happen? Clear values and meaningful work. If you think of those areas and the negative ones, but what would they look like? Here's one sort of path, and how can we begin to build this?

11A fairness success story

Quickly, a success story. This is another organization, not healthcare, not tech. But in the beginning when we worked with them and we assessed, it was almost 1,000 people in this organization. So what you're seeing there are the mean scores on the six areas, workload, control, rewards, community, fairness, and values. And the CEO thought workload and rewards were going to be the big negative issues. Very surprised to discover, uh-uh. It was values and fairness. He said, "Oh my gosh, people think we're not a fair organization? We have to do something about this." And they did. They found all kinds of things that people, the employees, felt were really unfair. They made changes. One of the worst was a distinguished service award. Came with a extra bonus paycheck, and people hated it because it was so unfair who got that award. And so, a year later, after they had taken that award apart, changed it, got everybody in the company to really say, "Okay, now we're doing the right thing." A year later when we came in and assessed it, those six areas turned around. Fairness in particular, but look at the spillover effect that it had on everything else, and this is a very common kind of thing. So fairness was the issue. How we do things here is really, and we can make positive changes. This organization was one of the first that I worked with in partnering on research and consulting. And they have continued to do this process on their own ever since then because it has worked so well for them as an annual process.

12Small, local changes and the help she is looking for

So six strategic paths, many possibilities, all of those areas to improve a good fit between people and their job. And the good news is that you don't have to do big, huge, expensive things. You can make small changes. Small, inexpensive, customizable. Important thing is that one size does not fit all. And secondly, you really have to get input from the people who are going to be doing this and carrying this out. So it can be done with teams, it can be done with groups, units, but it's that social thing of saying, "What would make this job better within this area? Can we try it out and see what happens?" The great thing about doing these changes, like this organization on fairness, is that it builds a sense of optimism and hope. If we could do that, get rid of this awful thing that everybody hates, and actually come up with something good, think what else we could do. And people talk about the pebbles in their shoes, the things that, ugh, are difficult, are irritating, get in the way. You can begin to make changes there, and create a healthier environment so that people are really thriving and growing in that. So final note, burnout shop is not a viable, I don't think it's a desirable future for our workplaces. We have now at Berkeley, UC Berkeley, an interdisciplinary center that is bringing together people from all kinds of areas to talk about what makes a good workplace, a healthy workplace where people are thriving, growing, developing, doing good work. So I'm learning a lot from architects, and from medical doctors and public health, and they're learning, hopefully, psychology from me and others. And we are really undertaking a challenge to say, how can we come up with better guidelines for what are ways to think about designing places where people are really going to thrive rather than being beaten down? So what's the help I'm looking for? I would love to get more examples of success stories of the kind like the organization that tackled fairness and figured out how to do it a lot better. And also through the center, how can we establish better partnerships between research and practice? We now work with different organizations, different companies in the San Francisco Bay area right now, but we can go anywhere. And I was just in Norway last week to do some work there. And we really want to be able to partner in a way to say, how can we develop new solutions, try it out, actually get evidence on what works, what doesn't, what has potential, and how can we then help broadcast that out to a lot of other people and a lot of other organizations so that we can really beat burnout, make it less and less of a problem, and build a lot more of engagement in the workplace? So thank you very much.