7 minute read
How to Cure the Public Health Crisis of Burnout an Occupational Disease
Background
To prevent the unhealthy and often toxic workplace conditions that lead to demoralization and burnout, organizations must recognize and remove unconscious bias from their leaders, their policies, and their processes. By operationalizing the autocratic-democratic belief-behavior systems© framework, leaders can now understand where unconscious bias occurs in our thinking, why it is so difficult for us to recognize, and how we can learn to overcome it. Additionally, this framework describes the science of social justice and democracy, why humanity often struggles to achieve social justice and democracy, and how we can create true democracy and social justice within our social systems. And finally, this framework describes the human thinking and human behaviors that result in diversity, equity, and inclusion, social values being sought in nearly all sectors of society. This organizational investment in democratizing our leaders, policies, and processes is essential to create engaging, protect and serve cultures that not only prevent burnout but that also exceptionalize the health and wellbeing of frontline workers which subsequently drives organizational success and sustainability.
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Defining Burnout
Nearly one third of US adults suffer from symptoms of depression (National Institute of Mental Health, 2020) or anxiety (National Institute of Mental Health, 2007) each year. This widespread mental and public health crisis commonly recognized as “burnout” (World Health Organization, 2019) and “adverse childhood experiences (ACEs),” (Walsh et al, 2019) does not stem from pervasive brain dysfunction, but rather is the result of systemic organizational dysfunction.
Mihal Emberton, MD, MPH, MS
Many businesses and organizations today share the laudable goal of creating workplace cultures where frontline workers are not only intrinsically valued, but one where frontline worker knowledge, insights, and experiences are sought out and effectively used to solve organizational problems. Unfortunately, many organizations are far from this utopia because hierarchies generally insulate rather than eradicate the unconscious biases within their policies, their processes, and their leadership. The persistence of these unconscious biases goes on to create and support cultures of coercion, suppression, and status quo, cultures of burnout. (Emberton, 2020, 2021) The United Nations’ International Covenant on Economic, Social, and Cultural Rights emphasizes
“ The right of everyone to the enjoyment of just and favourable conditions of work, which ensure, in particular safe and healthy working conditions, [especially] the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and the prevention, treatment, and control of occupational diseases.”
Additionally, the World Health Organization emphasizes that burnout is an occupational disease resulting from chronic workplace stress that has neither been successfully addressed nor prevented by the workplace. (World Health Organization, 2019) To prevent the unhealthy and often toxic workplace conditions that lead to demoralization and burnout, organizations must recognize and remove unconscious bias from their leaders, their policies, and their processes.
In order to address the unconscious bias of leaders, organizations must train each leader to recognize when they have unconsciously toggled into their autocratic belief-behavior system ©. Because there is a pattern to human behavior, human behavior is not only fascinatingly predictable, but it is thankfully changeable. Once a leader recognizes the signs and symptoms and patterns of their own autocratic thinking and autocratic behaviors, they can then learn to toggle into their democratic beliefbehavior system © more often, ideally always.
It is no secret to frontline workers as to which mindset their leader has toggled into because feelings and thoughts are clues and behaviors are evidence of their leader’s unconscious beliefs.
Leaders’ Behaviors sustain Workplace Culture
The mindset of the leader not only determines the workplace culture, but it also determines how that leader views and utilizes organizational resources. When leaders are in their autocratic belief-behavior system©, they stockpile the resources for learning (time and money) away from the people doing work, even though the people doing the work fund that organizational time and money. In a democratic culture, the people doing the work can and do have a fundamental role in correctly allocating organizational time and money to solve organizational problems.
Additionally, the mindset of the leader also determines whether that leader will be able to effectively solve organizational problems. When leaders are in their autocratic beliefbehavior system©, they do not recognize the knowledge, insights, and experiences of frontline workers as a resource for learning and thus they behave like judges who listen to only one side of a case before issuing a ruling, making uninformed, unjust, and generally wrong decisions. Whereas leaders in their democratic belief-behavior system © rightly use the intellectual currency of frontline workers to comprehensively understand problems and collaboratively generate solutions, producing informed, just, and generally effective organizational outcomes.
Democratic Policies help Leaders maintain Democratic Belief-Behavior Systems
Organizations often try to overcome the unconscious bias of their leaders by encouraging frontline workers to “speak up” and “share their knowledge, insights, and experiences” about how to improve the organization. When frontline workers are invited and allowed to collaborate and share their knowledge, insights, and experiences to solve organizational problems, true innovation and growth can occur, a truth also asserted by Albert Einstein in 1954:
“By academic freedom I understand the right to search for truth and to publish and teach what one holds to be true. This right also implies a duty: one must not conceal any part of what one has recognized to be true. It is evident that any restriction of academic freedom acts in such a way as to hamper the dissemination of knowledge among the people and thereby impedes rational judgment and action.”
This strategy appears to be a reasonable one on the surface because the frontline workers do own the intellectual currency that is necessary for solving organizational problems justly and effectively. However, the fundamental flaw with this strategy is that when leaders are in their autocratic belief-behavior system©, the knowledge, insights, and experience of frontline workers creates discomfort in the autocratic leader, who subsequently punishes and/or censors frontline workers to prevent further discomfort. Einstein described this dysfunctional pattern of autocracy poignantly when he wrote, “A dictatorship means muzzles all round, and consequently stultification. Science can flourish only in an atmosphere of free speech.”
Recognizing the unfortunate truth that leaders often continue to unconsciously toggle into autocracy, organizations committed to social justice, success, and sustainability will create organizational policies to help them overcome this encumbered reality. Such an organizational policy, for example, to protect frontline workers from censorship and retaliation for their freedom of speech looks like:
“The organization agrees that academic freedom, the right and responsibility to study, investigate, present, interpret, and discuss all the relevant facts and ideas in the field of a frontline worker’s professional competence, is essential to the fulfillment of the purposes of the organization; and the organization acknowledges that fundamental need to protect frontline workers from censorship or restraint which interferes with a frontline worker’s obligation to pursue truth in the performance of their jobs within the organization.”
Additionally, organizations committed to creating and maintaining a protect and serve democratic culture, in alignment with United Nations and World Health Organization values, will develop policies, for example, that correct discrepancies between shareholder rights and employee rights: “Protecting the civil and human rights of all employees and shareholders is fundamental to the purposes of our organization; and our organization holds itself accountable and responsible to adhere to state and federal labor, civil, and human rights laws for both employees and shareholders alike.”
When organizational policies and processes are used to guide and assist leaders in maintaining a democratic mindset, rather than to regulate and oppress frontline workers, they begin to justly sustain organizational cultures of innovation and growth. Further examples of such policies are 1) those that shift the accountability of leaders from the top of the organization back down to the frontline workers via elections rather than promotions, 2) those that promote democratic use of feedback mechanisms to help leaders find and overcome their unconscious bias, and 3) those that incentivize and appropriately equip frontline workers to perform their jobs effectively and comfortably.
Democratic Belief-Behavior systems, preserved by Democratic Policy, cure Burnout
Because unconscious bias is a human condition and we can all unconsciously toggle into autocracy, organizations must not only train their leaders how to toggle into their democratic belief-behavior system©, but they must also create and maintain democratic policies and processes to continuously guide, direct, and even forbid their leaders from unconsciously toggling back into their autocratic belief-behavior system©; these are the organizational investments that are necessary for creating democratic, protect and serve cultures that not only prevent burnout but that also exceptionalize the health and wellbeing of frontline workers which subsequently drives organizational success and sustainability.
Mihal Emberton, MD, MPH, MS practices at Kaiser San Francisco and is Clerkship Site Director, UCSF Department of Family & Community Medicine and Associate Clinical Professor, UCSF Department of Family & Community Medicine.
