Burnout is a severe problem affecting medical personnel and healthcare organizations. Medical personnel are experiencing a rapidly changing work context due to new technology and increased market pressure. Changes to organizations and care delivery models impact the way care is delivered and how care is experienced by patients. It is not surprising that burnout is high in healthcare settings with physician burnout rising dangerously.
Burnout has many personal costs including physical illness, increased feelings of hopelessness, irritability, impatience, poor interpersonal relationships with family/coworkers/patients, and drug abuse. In severe cases, burnout can cause diminished executive functioning, attention, and memory.
Burnout has many organizational costs including absenteeism, increased turnover, and decreased job performance. These consequences have a direct negative effect on patient safety, satisfaction, and quality of care.
Burnout must be assessed for severity and cause, and remedied by individual intervention and meaningful organizational change programs.
Maslach Burnout Toolkit™ and Maslach Burnout Inventory™ are trademarks of Mind Garden, Inc.
As the leading measure of burnout validated by more than 35 years of research, the Maslach Burnout Inventory (MBI) Human Services Survey for Medical Personnel specifically addresses the needs of the medical community. In combination with the Areas of Worklife Survey (AWS), the Maslach Burnout Toolkit will assess burnout among your medical personnel and identify key areas of strength or weakness in your organizational setting that may be causing burnout.
The Maslach Burnout Inventory (MBI) assesses:
Emotional Exhaustion: feelings of being emotionally overextended and exhausted by work.
Depersonalization: unfeeling and impersonal responses toward patients.
Personal Accomplishment: feelings of competence and successful achievement in one's work with patients.
The Areas of Worklife Survey (AWS) measures aspects of the work environment which may be contributing to burnout:
Workload: amount of work to be done in a given time. Workload measures the extent to which work demands spill into one's personal life. It reflects the social, physical, and intellectual burden of work demands.
Control: opportunity to make choices and decisions, to solve problems, and to contribute to the fulfillment of responsibilities. Control is the participation in important decisions about work and the range of professional autonomy.
Reward: financial and social recognition received for contribution on the job. Reward includes praise, awards, perks, and salary.
Community: quality of the social context at work, encompassing relationships with managers, colleagues, subordinates, and patients.
Fairness: extent to which the organization has consistent and equitable rules for everyone, or the quality of justice and respect at work.
Values: what matters to the individual in their work. The focus is the consistency between personal values and the values inherent in the organization.
The Group Report calculates and summarizes average AWS and MBI scores for your organizational group. Use this tool to organize your group data and understand which areas in your organization are contributing to burnout. The Group Report provides guidance on what can be done to prevent and remedy burnout in your organization.
The Individual Report interprets an individual's AWS and MBI assessment scores, provides burnout profile comparisons, and recommends action steps to remedy burnout and address organizational issues. View a sample Individual Report.
The Transform Survey Hosting License provides AWS and MBI online assessment with automated data and scale scoring in a downloadable file. View sample items.
Organizations frequently want to sort their results by medical specialty, facility location, or other attributes. This enables administrators to focus remediation efforts where they are most needed. Mind Garden can customize your survey and reports to add demographics, logos and other instruments. If you use the standard list of medical specialties (see below), customization may not be needed.
Textual input items
Ask your participants open-ended questions to elicit powerful ideas for organizational improvement. Their responses will be included in the reports. Examples of questions:
Add other instruments to your survey
You can add other instruments to your survey for a fee. Listed below are some standardized instruments you may want to use to assess physician well-being:
Physician Job Satisfaction Scale
"My work schedule leaves me enough time for my personal/family life."
Likert scale: Strongly agree, agree, neutral, disagree, strongly disagree.
Reference: Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population
Tait D. Shanafelt, Sonja Boone, Litjen Tan, Lotte N. Dyrbye, Wayne Sotile, Daniel Satele, Colin P. West, Jeff Sloan, Michael R. Oreskovich. Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199.
Individuals who indicated strongly agree or agree were considered to be satisfied with their work-life balance, whereas those who indicated disagree or strongly disagree were considered to be dissatisfied with their work-life balance.
Brief Fatigue Index (BFI)
The BFI assesses the severity of fatigue and the impact of fatigue on daily functioning.
Permission to reproduce must be purchased from the MD Anderson Cancer Center.
Stanford Sleepiness Scale
The Stanford Sleepiness Scale (SSS), developed by Dement and colleagues in 1972, is a one-item self-report questionnaire measuring levels of sleepiness throughout the day. The scale, which can be administered in 1–2 minutes, is generally used to track overall alertness at each hour of the day. The scale has been validated for adult populations aged 18 and older. The SSS is used in both research and clinical settings to assess the level of intervention or effectiveness of a specific treatment in order to compare a client's progress.
Epworth Sleepiness Scale
Permission to reproduce must be requested by Mapi Research Trust.
Short Form Health Survey (SF)
SF-36 is a set of generic, coherent, and easily administered quality-of-life measures.
Permission is available from the Rand Corporation.
Linear Analogue Self Assessment Scale
Measures overall quality of life in a single item.
Permission: This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
A lot of burnout blogs and media stories advise changing personal behaviors to prevent or remedy burnout. Common advice includes managing exercise and sleep habits, and learning new coping strategies such as yoga and meditation. While changes to personal habits and routines can certainly help individuals become more resilient against burnout, they do nothing to address the actual areas of work that are causing stress in the first place. Burnout prevention and remediation begins and ends with organizational change.
The root causes for every team's or department's burnout are organizational problems and therefore the solution rests in deliberate organizational change. For example, if Workload is one of the major problems, you can implement strategies to increase headcount for the team or adopt Lean Six Sigma practices. Or if there is a problem in Control, you can create a system to intervene in situations where employees feel micromanaged. Luckily, there are solutions to strengthen every work environment domain measured by the AWS - some simple and others more complex. The Maslach Burnout Toolkit Group Report lists intervention suggestions for each work area and is a great resource for designing burnout solutions.
Remember: in order to fully remedy and prevent burnout, solutions must focus on organizational change - not personal change. If the work environment continues to be overwhelming or toxic, no amount of exercise, sleep, yoga, or meditation will alleviate burnout for good. Be an organization against burnout - create meaningful change now!
IBM Watson Health's Simpler Consulting has a proven approach to help healthcare organizations address burnout. Simpler Consulting has experience with the Maslach Burnout Toolkit and can help transform those analyses into a meaningful and sustainable burnout solution. Learn more about Simpler Consulting's process in this Solution Brief, or contact Paul DeChant directly at email@example.com.
(Mind Garden receives no financial compensation for this recommendation. We promote resources that we truly believe are valuable to our customers and originate from trustworthy sources.)
Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine
DeChant, P., & Shannon, D. W. (2016). Preventing physician burnout: Curing the chaos and returning joy to the practice of medicine. North Charleston, SC: CreateSpace Independent Publishing Platform.
The Lean Prescription: Powerful Medicine for Our Ailing Healthcare System
Gabow, P. A., & Goodman, P. L. (2015). The Lean prescription: Powerful medicine for our ailing healthcare system. Boca Raton, FL: CRC Press.
Reignite: From Burned Out to On Fire.
Gaither, C. (2018). Reignite: From burned out to on fire. Lifestyle Entrepreneurs Press.
Banishing Burnout: Six Strategies for Improving Your Relationship with Work
Leiter, M. P., & Maslach, C. (2005). Banishing burnout: Six strategies for improving your relationship with work. San Francisco, CA: Jossey-Bass.
The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It
Maslach, C., & Leiter, M. P. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass.
Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being
National Academies of Sciences, Engineering, and Medicine. 2019. Taking action against clinician burnout: A systems approach to professional well-being. Washington, DC: The National Academies Press.
Making a Significant Difference with Burnout Interventions: Researcher and practitioner collaboration (Maslach, C., Leiter, M.P., & Jackson, S.E., 2012).
Maslach, C., Leiter, M.P., & Jackson, S.E., (2012. ). Making a significant difference with burnout interventions: Researcher and practitioner collaboration. Journal of Organizational Behavior, 33, 296–300.
Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout (Shanafelt & Noseworthy, 2016).
Shanafelt, T. D., & Noseworthy, J. H. (2016). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129-146.
The Business Case for Investing in Physician Well-being (Shanafelt, Goh, & Sinsky, 2017).
Shanafelt, Goh, & Sinsky (2017). The Business Case for Investing in Physician Well-being. JAMA Internal Medicine, 119 (2), E1-E7. Includes an excellent Figure 1, "Typical Steps in an Organizations Journey Toward Expertise in Physician Well-being."
An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice (Swensen & Shanafelt, 2017)
Swensen, S. J., & Shanafelt, T. (2017). An organizational framework to reduce professional burnout and bring back joy in practice. The Joint Commission Journal on Quality and Patient Safety, 43(6), 308-313.
Your leadership team has responsibility for preparing employees for your solution, leading implementation of the solution, and soliciting feedback about the solution's effectiveness. Set up your burnout solution for success by developing Transformational Leadership and Psychological Capital. Together, Transformational Leadership and Psychological Capital (PsyCap) can create greater alignment around your vision for change, decrease cynicism, and build unit cohesion and commitment. Transformational Leadership and PsyCap can be measured and developed using the Multifactor Leadership Questionnaire™ (MLQ) and Psychological Capital Questionnaire (PCQ), respectively.
Transformational leadership is influencing others’ awareness of what is important. It moves people to see themselves and the opportunities and challenges of their environment in a new way. Transformational Leadership creates greater alignment around strategic visions and mission, greater unit cohesion and commitment, lower turnover, and safer work environments.
Why Transformational Leadership for today’s healthcare organizations?
Healthcare organizations (a) are faced with turbulent conditions and rapid changes in technology, (b) must continuously develop employees to retain the best talent, and (c) are confronted with many more "unresolvable" and new problems.
The healthcare organization that supports and encourages the development of Transformational Leaders:
Note: section adapted from Multifactor Leadership Questionnaire Trainer's Guide Second Edition by Bernard Bass & Bruce Avolio (Copyright © 1999. 2011, 2018).
Transformational Leadership encompasses five leadership behaviors:
Measure and Develop Transformational Leadership in Your Organization
The Multifactor Leadership Questionnaire™ (MLQ) is the benchmark instrument to measure transformational leadership. Use the MLQ II 360 Suite to measure and develop Transformational Leadership in your organization’s leaders. This report provides a deep analysis of a leader's behaviors across a full range of leadership styles by gathering ratings and feedback from multiple stakeholders. It is a critical tool to develop leaders who can successfully initiate and sustain organizational change. You may also want to measure Authentic Leadership, which is related to other positive organizational outcomes, by using the MLQ 360 Leader's Report with Authentic Leadership Styles.
Multifactor Leadership Questionnaire™ is a trademark of Mind Garden, Inc.
Psychological Capital (or “PsyCap”) is an individual’s positive psychological state of development characterized by hope, efficacy, resilience, and optimism. An organization with high employee PsyCap can adapt quickly for successful organizational change initiatives.
PsyCap has undergone extensive theory-building and research and has been shown to:
PsyCap is state-like and can therefore be developed. Luthans, Avey, and Patera (2008) found that PsyCap can be developed effectively and cheaply through a short, highly focused web-based intervention.
PsyCap encompasses four characteristics:
Measure and Develop PsyCap in Your Organization
The Psychological Capital Questionnaire (PCQ) measures PsyCap with 24 items and has undergone extensive psychometric analyses and support from samples representing service, manufacturing, education, high-tech, military, and cross-cultural sectors. Use the PCQ Multi-rater Report to measure and develop PsyCap in your organization’s followers. This report provides a deep analysis of your employees’ hope, efficacy, resilience, and optimism skills by gathering ratings from multiple stakeholders. The PCQ Individual Report is also available for self-assessments (without ratings from others). Use the PCQ Group Report to gain insight on your organization's average PsyCap. It is a critical tool to establish your employees’ readiness for organizational change.
Avey, J. B., Reichard, R. J., Luthans, F., & Mhatre, K. H. (2011). Meta-analysis of the impact of positive psychological capital on employee attitudes, behaviors, and performance. Human Resource Development Quarterly, 22(2), 127-152.
Avey, J.B., Wernsing, T. S., & Luthans, F. (2008). Can positive employees help positive organization change? The Journal of Applied Behavioral Science, 44, 48-70.
Clapp-Smith, R., Vogelgesang, G. R., & Avey, J. B. (2009). Authentic leadership and positive psychological capital: The mediating role of trust at the group level of analysis. Journal of Leadership & Organizational Studies, 15(3), 227-240.
Luthans, F., Avey, J. B., & Patera, J. L. (2008). Experimental analysis of a web-based intervention to develop positive psychological capital. Academy of Management Learning and Education, 7, 209-221.
Luthans, F., Norman, S. M., Avolio, B. J., & Avey, J. B. (2008). The mediating role of psychological capital in the supportive organizational climate-employee performance relationship. Journal of Organizational Behavior, 28, 219-238.
Peterson, S. J., & Zhang, Z. (2011). Examining the relationships between top management team psychological characteristics, transformational leadership, and business unit performance. In M. A. Carpenter (Ed.), Handbook of top management research (pp. 127-149). New York, NY: Edward Elgar Publishing.
Mind Garden is one of over 150 organizations that have submitted an organizational commitment statement in support of National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience. See our commitment statement below or view a full list of organizations who have submitted formal statements.
Burnout is a severe problem affecting medical personnel and healthcare organizations. Burnout is defined as emotional exhaustion, depersonalization, and low feelings of personal accomplishment. Burnout has many consequences for the individual including physical illness, increased feelings of hopelessness, irritability, impatience, poor interpersonal relationships with family/coworkers/patients, and drug abuse. In severe cases, burnout can cause diminished executive functioning, attention, and memory. Burnout has many organizational consequences including absenteeism, increased turnover, and decreased job performance. These consequences can have a direct negative effect on patient safety, satisfaction, and quality of care. Burnout must be assessed for severity and cause, and remediated by individual intervention and sophisticated organizational change programs.
Mind Garden is fully committed to the development of products and services that support researchers, healthcare organizations, and medical personnel in the assessment, prevention, and remediation of burnout in the medical field. We will continue to work in the following areas:
Publish and support the Maslach Burnout Inventory (MBI): The MBI is recognized as the leading measure of burnout and has been validated by extensive research since 1981. The MBI is used to assess professional burnout and understand the nature of burnout for developing effective interventions.
Publish and support the Areas of Worklife Survey (AWS): As a companion tool to the MBI, the AWS scores profile can help identify work-setting causes of burnout.
Offer Customization Services: Support survey customization and Group Report customization on our Transform™ system. We are determined to make it easy and affordable for healthcare organizations and other stakeholders to collect and interpret burnout scores. Burnout data can be parsed by demographics such as hospital/clinic location and medical specialty.
Support Affordable Research: Offer products and services at reasonable rates to support affordable assessments by researchers and students.
Prevention and Remediation
Develop educational resources: In conjunction with burnout researchers, provide information to educate medical organizations about burnout prevention and remediation.
Support burnout measurement at the individual and organizational levels.
Publish burnout surveys: Provide surveys that facilitate a better understanding of the extent and cause of burnout.