Understanding & Responding To Burnout & Moral Injury

Senior Consultant OH Physician // DR. SIMON CLIFT

Psychosocial & Wellbeing Lead // BEN PORTER

We’ve seen a rise in both burnout and moral injury among clients lately. And so in a recent webinar two of our experts unpacked these buzzwords to help clients understand and respond to these challenges. Here’s some of what they shared.

Burnout isn’t a medical condition as such. In the International Classification of Diseases it is described as an “occupational phenomenon” resulting from “chronic workplace stress that has not been successfully managed”. However, it can lead to mental health issues like depression, anxiety, insomnia and physical illnesses.

Moral Injury describes the psychological distress that comes from perpetrating, witnessing, or failing to prevent acts that clash with one’s moral code. A key aspect of it is feeling complicit in something going wrong. Signs of it include: guilt, shame, anger, a loss of meaning, trust issues, self-blame, and withdrawal from colleagues. It can lead to absenteeism, decreased productivity, isolation, embitterment and litigation. We are seeing it all over the place at the moment.

Moral injury has various causes. They include: being forced to act against values, witnessing unethical behaviour, organisational betrayal, being unable to provide adequate care/service; leadership failures; and resource constraints forcing compromise. We heard various examples, such as the aid worker in a conflict zone for whom the fact that she had food to eat whilst the people she treated did not, caused her intense feelings of guilt.

Both burnout and moral injury have become more common in recent years, for a cocktail of reasons. We grouped these reasons into four areas. Firstly, the shift to remote work since the pandemic, an ‘always-on’ digital culture, and more porous work-life boundaries. Secondly, constraints and cutbacks in many sectors. Thirdly, a lack of wider cultural consensus about what is virtuous, and the nobility of being a healthcare worker or humanitarian. Fourthly, existential anxiety surrounding global uncertainty and conflicts without obvious resolution.

The demands of a job are big causes of burnout, but they are not the only causes. We need to consider workload, time pressure, emotional strain, administrative burden, and role clarity. But the individual is a big part of the jigsaw too: personal characteristics can make someone more susceptible or resilient to burnout (personality, neurodiversity, physical health, sense of vocation). Another important factor is the culture, values systems and leadership of an organisation. And finally, wider society: government policy & public opinion can be a factor, albeit one that is harder to measure.

Line managers can play a big part in spotting the early warning signs of burnout. They should check in regularly with their direct reports and keep an eye out for its signs. These signs may be physical (e.g. persistent tiredness, poor sleep, headaches; muscle tension, frequent minor illness), emotional (e.g. irritability, impatience, loss of motivation, anxiety, low mood, overwhelm); cognitive (e.g. poor concentration, slower thinking, more errors, cynicism); behavioural (e.g. withdrawal, social isolation, procrastination, under-performance, presenteeism); values (e.g. loss of purpose or calling; values clash with job demands;istress at not delivering care). Also, pay attention to staff engagement surveys, staff retention and sickness absence rates.

Being part of a good team is a powerful buffer against burnout. That sense of solidarity and camaraderie – of being in it together – is hugely helpful. But the converse is also true: where there is conflict, bullying or social isolation, burnout becomes more likely.

Rather than a ‘burnout prevention strategy’, we suggest organisations develop a ‘healthy engagement in work strategy’. This, really, is our raison d’etre at Thrive. When we began we developed a series of principles along these lines that govern our work, and shape services. They include principles around collaborative leadership and team cohesion, and via services such as this one, we can help you develop a culture that will propel and sustain you towards your organisation’s goals, even during hard times.

At an individual level, simple measures can have a big impact. It might help to simply measure your working hours, to put into practice a time-off-in-lieu policy for yourself, and to ensure you take all your annual leave. Also consider what adjustments or preferred ways of working might be needed that are unique to you. Consider if any underlying physical or mental illnesses might be a contributory factor to a work issue.

To support someone who is struggling with moral injury, start by sitting down to listen to them. Validating their experience does more than you can imagine, so acknowledge how hard it must be, without assuming you understand exactly what it is like. Help them see that the situation is not their fault. Think how you can support them to trust themselves again: they may feel naive or duped or have a lack of confidence as a result of their moral injury. And encourage people to see they are more than just their profession: a partner, parent, athlete, friend.

As burnout builds over a long period of time, recovery too can take a long time. Six months to a year is common, and so taking a short rest and going back into the frey makes no sense: the same thing will happen over again. There is a book called The Joy Of Burnout that talks about how the idea of running out of steam and grinding to a halt is an opportunity to reflect, reconsider and rediscover what matters to you.

With Moral Injury, a person can get stuck in a kind of passive resignation. People need help to find a sense of responsibility or agency no matter how small “it might not be much but i can do this”.When you feel trapped, ask where is the wiggle room? What small steps can you take? After several small steps, you may find yourself in a new place.

An Occupational Health Assessment – one of our core services – is a good way to properly tease out some of the issues at the interface between a person’s health and your work. And the Reflective Practice we offer is a great group activity to think about how a team can respond to a difficult set of circumstances, in a way that develops individual and collective resilience. You might also like to consider our e-learning course our Supporting Staff In High Risk, Insecure Environments e-learning course.

If you’d like to discuss how we can help you or your team work through issues of burnout or moral injury, then we would love to help. Get in touch with us here.