IDENTIFICACION CONFLICTOS

Maslach & Leiter (2017) point out that burnout and its improvement are the responsibility of both the organization and the individual. This section looks at both individual and organizational prevention and treatment approaches. Swensen & Shanafelt (2017) argue that organizations have the responsibility to encourage not only a healthy social and civil workplace environment but to reduce the organizational causes of burnout identified as workload, resources and control while building resiliency in their employees. Swensen & Shanafelt (2017) show the “value in fostering communication, instituting structural changes, cultivating teamwork, supporting stress management tactics, enhancing job control, and focusing on leadership skills” (p. 5).

Individual prevention and treatment

Authors point out that there are no consensus treatments to prevent or improve the effects of burnout in individuals (Ahola et al., 2017; Krasner et al., 2009; Luken & Sammons, 2016; Panagioti et al., 2017; Perez et al., 2015; West et al., 2016). They note that many of the studies on treating burnout struggle with design flaws related to small sample sizes, of limited duration and with insufficient control groups. Several authors point out that prevention is both more efficient and effective than the treatments of burnout (Back et al., 2016; Dyrbye & Shanafelt, 2016; Raj, 2016). The prevention of

burnout at the individual level needs to strengthen a person’s skills as related to strain and stress management negating the need to treat the secondary symptoms of burnout in their physical or mental health (Dyrbye et al., 2017; Sapolsky, 2004). The focus then changes from mental “illness” to the development and strengthening of mental “health.” Chaukos et al. (2017) report that their research on medical residents shows that the most valuable skills to develop are mindfulness and coping skills. They define coping skills as self-awareness of your physical/emotional/mental body, stress management, relaxation skills, cognitively working with negative thoughts, and communication skills (Chaukos et al., 2017). Wild et al. (2014) report that relaxation skills improve “cognitive and emotional burnout stress” (p. 1).

It is also important to note that while treatments are unclear, the

recommendations for prevention and treatment of burnout highlight two points that relate to my research area: mindfulness is helpful and shows fair to good results, and group skills vary but are important to both prevention and treatment of burnout. This, combined with organizational change, is necessary to address the burnout syndrome.

Organizational interventions would focus on workload issues, control issues, reward and compensation, civility among workers, fairness among a team and organization-wide, and the values of the organization (Maslach & Leiter, 2017).

Several authors point out teachable skills can improve that burnout (Back et al., 2016; Maslash & Leiter, 2017; Van Mol et al., 2015; Wilkinson et al., 2017). Dyrbye & Shanafelt (2016) recommend students and trainees in healthcare professions have treatment and support available to them outside of their educational structures. They state that students need to “obtain treatment for mental or emotional concerns” (Dyrbye & Shanafelt, 2016, p. 141). Education is vital in the development of the complex coping skills needed in a rapidly changing work environment with its fluid social dynamics

(Maslash & Leiter, 2017; Van Mol et al., 2015; Williams, Tricomi, Gupta & Janise, 2015). Mindfulness and group skills are positive traits and protective factors in an

individual’s struggle with burnout. Several authors point out the importance of

engagement, wellness and resiliency as the counter to burnout and state the importance of organizations engendering these skills in employees (Mckinley et al., 2017; Panagioti et al., 2017; Schrijver et al., 2016; West et al., 2016).

Organizational remediation

To proactively address the potential for burnout in healthcare staff, organizations need to engage their employees actively. Too often, large modern organizations have overlooked the staff dimension of healthcare, focusing instead on efficiency and monetary costs. However, the danger in doing so is to undervalue the human costs. These human costs, initially hidden, end up becoming explicit costs affecting health and effectiveness in a variety of ways. As we have seen, decreases in staff commitment result in increased healthcare costs (Portoghese et al., 2014; Swensen & Emlet 2015).

Additionally, increased symptoms of burnout are associated with decreases in patient safety and quality of care and increases in healthcare costs (Shanafelt & Noseworthy, 2017; Van Bogaert et al., 2014). Healthcare is a human endeavour, and as such, organizations need to consider the human needs of healthcare professionals to encourage engagement and enhance effectiveness (Epstein & Privitera, 2016; Hakanen, Schaufeli & Ahola, 2008; Swensen & Shanafelt, 2017). Human limitations, social needs and organizational vision matter and need to be addressed (Epstein & Privitera, 2016). Maslach & Leiter (2017) highlight the social environment in both the development and the prevention and treatment of burnout, emphasizing the importance of “civil, respectful social encounters” (p. 160). They note that civility is a trainable skill. As a method to understand and arrest burnout, Maslach & Leiter (2017) propose that healthcare organizations engage in the following:

• Know the problem: Get educated about what burnout is and what to do about it.

• Enhancing team perspective: Developing skills to work well with others. • Build a culture of appreciation: Giving and receiving recognition.

• Realistic recovery: Strategies and support for restoring energy. (p. 160) There is overwhelming support in the literature for a multilayered approach considering organizational change, individual training and healthcare student education to preventing and addressing burnout in the workplace (Back et al., 2016; Dyrbye & Shanafelt, 2016; Epstein & Privitera, 2016; McKinley et al., 2017; Panagioti et al., 2017; Schrijver et al., 2016; Williams et al., 2015). The research literature shows that it is an educational and organizational responsibility to do something now to meet current and

future demands for healthcare professionals (Haramati, Cotton, Padmore, Wald & Weissinger, 2017). Ahola et al. (2017) conclude that organizations need to methodically approach the remediation of burnout and burnout, causing factors in their organizations. Maslach & Leiter (2017) recommend that “specifically, the effectiveness of both the academic content and supervised practice would be enhanced by giving a greater emphasis to the social dynamics of healthcare teams” (p. 160).