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Abstract

Burnout research over the past 30 years has yielded both knowledge and tools to apply to interventions at unit and organizational levels. Examples of innovative partnerships between researchers and practitioners point to the importance of multi-level approaches in generating relevant and effective solutions to the burnout problem.
The
Incubator
Making a signicant difference with burnout
interventions: Researcher and practitioner
collaboration
CHRISTINA MASLACH
1
*, MICHAEL P. LEITER
2
AND SUSAN E. JACKSON
3,4
1
Psychology Department, University of California, Berkeley, California, U.S.A.
2
Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada
3
School of Management and Labor Relations, Rutgers University, Piscataway, New Jersey, U.S.A.
4
Lorange Institute of Business, Zurich, Switzerland
Summary Burnout research over the past 30 years has yielded both knowledge and tools to apply to interventions at unit
and organizational levels. Examples of innovative partnerships between researchers and practitioners point to
the importance of multi-level approaches in generating relevant and effective solutions to the burnout problem.
Copyright © 2011 John Wiley & Sons, Ltd.
Keywords: burnout; engagement; interventions; multi-level
Burnout became an issue of interest over 35 years ago when, quite independently, a practitioner (Freudenberger) and
a researcher (Maslach) began to write about this previously unrecognized phenomenon. And it has now been
30 years since the publication in the Journal of Organizational Behavior of the major research measure of burnout,
the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981). From the beginning, there was a high degree of
interest in what can we actually do about burnout?”—in other words, how can any new knowledge gained through
research be applied to the design of effective interventions? Conicting pressures from the worlds of both academic
research and workplace practice confronted the rst burnout researchers. Practitioners were impatient with the slow
pace of research and its ivory towernature, but burnout research would get derogated within academia as pop
psychology,or as simply old wine in new bottles,or as too applied rather than basic research.
Burnout research was exploratory at rst, very bottom-up and anchored in peoples experiences. Several themes
emerged from this research on human service professions, including the key responses of emotional exhaustion and
depersonalization to the overload of these demanding jobs, as well as a decline in ones sense of personal accom-
plishment. The development of a standardized measure of burnout was the necessary and signicant next step to
advance the research eld. Two of us, Maslach and Jackson (1981), took on that psychometric challenge and devel-
oped the MBI, which assessed the three themes listed earlier. Its most recent version, the MBI-General Survey was
developed for use in all occupations, not just human services, and the denitional terms of the three dimensions were
expanded to exhaustion, cynicism, and inefcacy (Schaufeli, Leiter, Maslach, & Jackson, 1996). The MBI has been
translated into many languages and has been the leading measure to assess burnout in research around the world; for
example, in Schaufeli and Enzmanns (1998) literature review, 90 per cent of the studies had used the MBI.
As we rened our theoretical framework for burnout, we conceptualized peoples psychological relationship to
their job as a continuum between the negative experience of burnout (exhaustion, cynicism, and inefcacy) and
*Correspondence to: Christina Maslach, Psychology Department, 3210 Tolman Hall, University of California, Berkeley, California 94720-1650,
U.S.A. E-mail: maslach@berkeley.edu
Copyright © 2011 John Wiley & Sons, Ltd. Received 4 September 2011, Accepted 16 September 2011
Journal of Organizational Behavior, J. Organiz. Behav. 33, 296300 (2012)
Published online 12 October 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/job.784
the positive experience of engagement (energy, involvement, and efcacy). This framework was consistent with re-
sponse distributions on the MBI that reected a smooth continuum of experience rather than a discrete condition of
burnout. The practical signicance of this burnoutengagement continuum is that engagement represents a desired
goal for any burnout interventions. Such a framework leads people to consider what factors in the workplace are
likely to enhance employeesenergy, vigor, and resilience; to promote their involvement and absorption with the
work tasks; and to ensure their dedication and sense of efcacy and success on the job.
Three decades of burnout research conducted at the individual level of analysis have resulted in a deeper
understanding of how individual employees react to their jobs, in terms of job dissatisfaction, low organizational
commitment, absenteeism, intention to leave the job, and turnover, as well as in their job performance (e.g., Aiken,
Clarke, Sloane, Sochalski, & Silber, 2002; Wright & Bonett, 1997). As research developed, burnout scholars
increasingly recognized that social and organizational conditions are primary correlates of burnout, particularly in
six broad domains of jobperson mismatch: work overload, lack of control, insufcient reward, breakdown of
community, absence of fairness, and value conict. Any or all of these areas may align well with employeespre-
ferences or capacities, encouraging engagement, whereas poor alignments may aggravate burnout. To operationalize
this conceptual framework, we developed the Areas of Worklife Scale (AWS) assessing the full continuum of
jobperson t to mist within these six domains (Leiter & Maslach, 2004).
So let us return to burnouts beginnings and the original plea to move quickly to test and develop possible
solutions to this problem. Are we in a better position these days, with greater knowledge and better tools, to respond
more effectively in terms of organizational interventions? We think we are. But we also think that a central incubat-
ing concept is to be more strategically pro-active about developing effective collaborations between researchers and
practitioners. Our recent work illustrates how such partnerships can improve the experiences of employees while
also contributing to organizational effectiveness.
Sharing Tools and Processes
Much of our recent research has been carried out with groups of workers within organizational settings, utilizing a
collaborative, shared tools and process we have called an organizational checkup.As a rst step, we develop a
customized organizational survey that is designed to produce a high level of employee response (70 per cent min-
imum). By combining our research measures with assessments of selected issues of concern to the specic
organization, the process engages managers and increases their interest and cooperation (Leiter & Maslach,
2000). Subsequently, the aggregated survey results for the organization as a whole, and for its major units, are shared
with all employees and become the basis for developing appropriate changes in the workplace. The combination of
the AWS and the MBI in these surveys has proved to be valuable for organizational assessments, because it can
depict what areas in the workplace are either problematic or sources of strength, as well as whether burnout is a
signicant issue in the organization and where. Moreover, longitudinal research using these two measures has shown
that different patterns of scores at Time 1 can predict work unit and organizational outcomes a year later, including
burnout rates (Maslach & Leiter, 2008) and work unit injury rates (Leiter & Maslach, 2009). Such ndings demon-
strate the practical usefulness of using the MBI and the AWS for organizational assessments to identify current
symptoms, anticipate potential future problems, and then develop early preventive interventions.
Although we originally developed the organizational checkup process to ensure high quality samples for our
research, we have found that it can become a valuable, ongoing self-assessment process for organizations. For
example, one of the rst organizations to collaborate with us has continued to use this process annually, for their
own improvement, for over 10 years. Some of their interventions involved redesigning staff recognition programs
and making them fairer, whereas others focused on improving community issues, such as internal communications
and leadership training for new supervisors. The lesson here is that the methods and tools developed for research
may have a second, practical use within the workplaceand we would recommend that researchers could provide
BURNOUT INTERVENTIONS 297
Copyright © 2011 John Wiley & Sons, Ltd. J. Organiz. Behav. 33, 296300 (2012)
DOI: 10.1002/job
a valuable social function by actively collaborating with practitioners to achieve these additional benets. This is a
different form of appliedresearch, and its value should be recognized, and encouraged, within the academy.
Using a Unit Level of Analysis for Intervention
For years, we have heard repeated calls for scholarship that has more apparent relevance to the everyday work of
practicing managers. The eld of organizational behavior has no singular answer to how best to achieve the desired
degree of relevancein our research, but addressing phenomena at higher levels of analysis is one possible strategy.
Organizations are designed and managed around work units. Usually, managers are held accountable for large
groups of employees, not only individuals. When their performance as managers is evaluated, the measures are
typically aggregated indicators, such as productivity, turnover rates, and work unit engagement. In organizations
where burnout is a potential issue, interventions to prevent or ameliorate it are often designed for, and implemented
across, entire departments or business units. Decisions about how to monitor and manage burnout are often made in
the context of the needs of an entire organizationor at least numerous units within the organization. Thus, the
relevance of future research on burnout may grow to the extent that it is conceptualized and conducted with the
objective of drawing implications and conclusions that apply to managing work units.
Prior research on burnout provides strategic directions for collaboration at these unit levels. First, the strategy for
organizational intervention is to change qualities of the work environment with strong links to enhanced employee
engagement. The diverse range of burnouts organizational precursors in the six domains of the AWS presents many
potential intervention targets. For example, a mismatch on the community area of worklife may suggest work on
team building or civility, whereas a mismatch on fairness may suggest increasing transparency of decision making.
The challenge is then to identify leverage points at which a feasible investment of resources would produce a
meaningful improvement in employeesconnection with their work.
An innovative example of this approach is a project on civility among coworkers. Research has found that
coworker and supervisor relationships have strong links with burnout (e.g., Leiter & Maslach, 1988), but clearer
evidence about the social mechanisms was only recently suggested by research on the negative impact of coworker
incivility (Pearson & Porath, 2009). Incivility is characterized by a lack of consideration and by demonstrations of
disrespect of ambiguous intent, as specied in the Workplace Incivility Scale, for example, Ignored or excluded
you from professional camaraderie(Cortina, Magley, Williams, & Langhout, 2001, p. 70). Because of its milder
nature and greater frequency, incivility provides different research or an intervention focus than relatively rare
instances of abuse or aggression.
A structured process, CREW (Civility, Respect, and Engagement at Work; Osatuke, Mohr, Ward, Moore, Dyrenforth,
& Belton, 2009), has been demonstrated to improve civility among coworkers; these results suggested that improved
civility would in turn affect employee burnout. The approach builds upon clear principles of respectful working
relationships while using a loose structure that allows workgroups to adapt the process to their specic challenges
and their local values. CREW seeks to infuse qualities of civility into workgroupspreferred style of interacting.
Qualities of civility include being attentive to colleagues, listening to their views and concerns, accommodating
one anothers preferences, and anticipating the impact of ones behavior on others.
The CREW process occurs through local facilitators who lead regular sessions of workgroup members over a
six-month period. Guided by a toolkit of group exercises and discussion topics, the group reects upon their usual
mode of interacting and explores alternatives. After role playing new ways of responding to colleagues, participants
try out new social behaviors during their workdays, reecting on these experiences in subsequent CREW sessions.
Using a waiting list control design, Leiter, Laschinger, Day and Gilin-Oore (2011) demonstrated that CREW not
only improved civility (replicating the Osatuke et al., 2009 ndings) but that improvements in civility also mediated
improvements in the cynicism dimension of burnout, job satisfaction, organizational commitment, and management
trust. This analysis provided support for the assertion that improving working relationships plays an important role
in alleviating burnout.
298 C. MASLACH ET AL.
Copyright © 2011 John Wiley & Sons, Ltd. J. Organiz. Behav. 33, 296300 (2012)
DOI: 10.1002/job
The research design for this project had several features of a successful collaboration of researchers and practitioners.
First, the problemworkplace incivilitywas identied in conversations between researchers and organizational
leaders as both an urgent issue needing solutions and a topic with a rich potential to contribute to knowledge. Second,
the participating organizations played a major role in the intervention, in that the facilitators were ongoing employees
who developed the capacity to facilitate CREW sessions. This quality gave the knowledge to the organizations to help
them address future challenges in workplace relationships. Third, each party made essential contributions to the project.
The organizations contributed the opportunity and facilitators; the researchers contributed high-quality measurement
that critically evaluated CREWsimpact.
Focusing on Multi-Level Effects
Scholarship within the broad eld of organizational behavior has rapidly expanded to consider phenomena at
multiple levels of analysis. By bringing a multi-level lens to investigations of organizational behavior, the eld is
beginning to develop deeper understandings of the complex intertwining of individual and social phenomena.
Looking ahead, we envision more multi-level approaches in future research on burnout as well.
More than 30 years have passed since Roberts, Hulin, and Rousseau (1978) laid out a framework for integrating
organizational scholarship grounded in microand macroapproaches. Multi-level models such as those recog-
nize that individuals are embedded in nested organizational entities. Employees often work closely with members
of a small work team, which resides in a larger business unit, which is embedded in an organization that spans
multiple geographic boundaries (e.g., districts, states, provinces, and countries).
Earlier research conducted at the individual level of analysis suggested the important role such social systems play
in the unfolding of burnout phenomena. With recent methodological and statistical advances, many practical barriers
to conducting research that matches the rich multi-level reality of organizational life have been removed. Multi-level
research promises to stimulate both new conceptual thinking and the development of knowledge that can be put to
practical use to reduce burnout in organizations. For example, separating the individual and workgroup dynamics of
exhaustion would provide direction for developing distinct interventions that focus on improving management
practices at the team level or workplace health practices at the individual level. Greater understanding of the distinct
social dynamics of organizational units has the potential to help sustain gains from organizational interventions.
Activities and policies that t the local context are more likely to establish self-perpetuating cycles of actions and
responses that maintain constructive change.
Burnout has a future. By anchoring a continuum of personal experiences, the burnout construct has provided a
foundation for continuing explorations of psychological connections of people with their work from both positive
and negative perspectives. We have touched upon the potential of these ideas for incubating new insights regarding
the social context of psychological relationships with work.
Author biographies
Christina Maslach, PhD, is a Professor of Psychology at the University of California at Berkeley. Her current
research is addressing cross-cultural comparisons of burnout and engagement in both China and Latin America,
as well as investigating potential interventions. For more details, visit http://maslach@socialpsychology.org
Michael P. Leiter, PhD, is Canada Research Chair in Occupational Health and Well-being at the Department of
Psychology, Acadia University. His current research addresses the social environments of work units, especially
the design of interventions to alleviate burnout through improving collegiality. For more details, visit www.
workengagement.com
BURNOUT INTERVENTIONS 299
Copyright © 2011 John Wiley & Sons, Ltd. J. Organiz. Behav. 33, 296300 (2012)
DOI: 10.1002/job
Susan E. Jackson, PhD, is a Distinguished Professor of Human Resource Management in the School of Manage-
ment and Labor Relations, Rutgers University. Her current research addresses workforce management issues in
environmentally sustainable organizations, work team diversity, and strategic human resource management systems.
For more details, visit http://smlr.rutgers.edu/SusanJackson
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This chapter evaluates a model of the organizational context of burnout with direct reference to a new measure, the Areas of Worklife Scale (AWS). The model proposes a structured framework for considering six areas of worklife – workload, control, reward, community, fairness, and values – that have resonated through the literature on burnout over the previous two decades. The chapter presents extensive data on the AWS, testing a model of the six areas’ interrelationships as well as their overall relationship to the three aspects of burnout. The results of these analyses are discussed in reference to the psychometric qualities of the measure and the implications of a structured approach to work environments for future development of research on burnout. Implications for developing workplace interventions are also considered.
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Context The worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.Objective To determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.Design, Setting, and Participants Cross-sectional analyses of linked data from 10 184 staff nurses surveyed, 232 342 general, orthopedic, and vascular surgery patients discharged from the hospital between April 1, 1998, and November 30, 1999, and administrative data from 168 nonfederal adult general hospitals in Pennsylvania.Main Outcome Measures Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission, and nurse-reported job dissatisfaction and job-related burnout.Results After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue. After adjusting for nurse and hospital characteristics, each additional patient per nurse was associated with a 23% (OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR, 1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.Conclusions In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses are more likely to experience burnout and job dissatisfaction.