tress and burnout are frequently used terms to describe the challenging aspects of employee experience. Sometimes these words are used interchangeably. While stress and burnout are related, it is important for leaders to understand the similarities and differences between these constructs, how they currently appear in U of U Health’s Better U survey, and how to best respond if concerned for their team. 

What is Stress? 

Stress is a normal response to change or a challenge that causes physical, emotional, or psychological tension or strain. Our bodies respond to stress by producing cortisol and releasing other chemicals that help us regulate stress and eventually return to our baseline functioning. Stress typically goes away after the stressor, or whatever caused the stress, leaves (e.g., end of a work shift, arrive to our destination after a difficult commute, wrap-up a crucial conversation) or we take a break (e.g., good night’s sleep, weekend, vacation). There are also things that we can do to help us work through the stress response cycle. 

Experiencing stress isn’t always negative. The Yerkes-Dodson law shows that stress can serve as a motivator for optimal performance, like preparing for an important presentation or engaging in a challenging clinical case. Like Goldilocks, it is important that the amount of stress we experience with a task is just right. Too little stress causes us to feel bored, too much stress causes us to feel overwhelmed, and both lead to worsening performance.  

Chronic stress occurs when the stressor remains, we are unable to experience much reprieve from the stressor, and our regulating system struggles to manage the continued onslaught of stress. Health issues like heart disease, immune dysfunction, sleep problems, and mental health struggles are associated with chronic stress.  

What is Burnout? 

Burnout is a work-related syndrome that is characterized by three primary features: 

1. Emotional exhaustion – the sense of complete depletion, feeling drained and worn out that isn’t resolved from typical time off.
2. Depersonalization – cynicism, detachment from patients, students, peers, colleagues, and purpose. 
3. Decreased sense of personal achievement – feeling ineffective, even if continue to perform well. 

Burnout is driven by a myriad of factors that are typically more system-related than individually driven, including, but not limited to, workload, process efficiency, team functioning, leadership communication, psychological safety and feeling valued. Burnout is also contagious within teams. 

The cost of burnout is high. Burnout is associated with significant personal struggles like depression, anxiety, PTSD, relationship issues, and even suicide. It is also strongly correlated with professional problems including decreased team functioning and patient satisfaction, increased medical errors, and high turnover. Physician burnout alone is estimated to cost the United States health care system $4.6 billion annually. Research indicates burnout rates in academic medical centers 1) increased by 27% between 2019 and 2022 and 2) tend to vary by role, specialty, type of shift, and hours worked.

How are stress and burnout related?  

Chronic stress can lead to burnout. Also, experiencing a significant stressor can be associated with burnout, especially when left unaddressed or untreated. This includes stress injuries like occupational trauma, complex loss or grief, moral distress, and continued wear and tear. The stress continuum, developed by Patricia Watson and the National Center for PTSD, provides a useful image of how stress and burnout interact.  

When working with U of U Health employees at the Resiliency Center, we have found that those who identify being in “green,” “yellow,” or “light orange” tend to experience stress with no burnout while those who are in “dark orange” or “red” are experiencing both stress and burnout. 

How are stress and burnout measured on the Better U survey?  

There are currently two items on the Better U survey related to stress and burnout.  

Stress: I feel a great deal of stress because of my job.  

• Strongly Disagree 
• Disagree 
• Neutral 
• Agree 
• Strongly Agree 

The bolded responses are used to show how much people agree (agreement rate). It is important to note that this item has not been validated as a single measure of work-related stress, and thus, should be interpreted as stress within a group and not an individual person (discrete measurement). 

Burnout: Using your own definition of burnout, please choose one of the items below: 

• I enjoy my work. I have no symptoms of burnout.  
• I am under stress, and don’t always have as much energy as I once did, but I don’t feel burned out. 
• I am beginning to burn out and have one more symptoms of burnout (e.g., emotional exhaustion). 
• The symptoms of burnout that I am experiencing won’t go away. I think about work frustrations a lot. 
• I feel completely burned out. I am at the point where I may need to seek help. 

The bolded responses are used to generate a burnout rate. This item has been validated as a single measure of burnout among healthcare professionals. 

Regarding stress and burnout, what should leaders look for in the Better U survey results?  

Overall, April 2024 Better U results indicate that 73% of U of U Health respondents either agreed or strongly agreed that they experience a great deal of stress because of their job and 39% of respondents endorsed experiencing burnout. Those in clinical roles had higher stress (75%) and burnout (43%) rates. General results also seem to suggest that burnout rates increase as stress rates increase and vice-versa.

It is important to note that there are no cut-off scores for the stress and burnout items within the current Better U survey. This means that leaders need to spend time understanding how these two data points manifest within and impact their group. In general, leaders should be curious about stress within their team, concerned about burnout, and very concerned if burnout and stress seem high. This interpretation is, in part, because the stress item within the current Better U survey does not indicate whether the stress experienced is negative or difficult to manage.  

Some questions for leaders to consider while reviewing Better U results: 

• Given my experience with my team(s), do the stress and burnout rates seem to match with what I’ve observed over the past 6 months?  
• Have these results increased or decreased since the last survey?  
• What do I think might be contributing to the current rates?
• What changes have occurred for results to shift one way or the other or remain the same? 
• How should leaders act on the stress and burnout results in the Better U survey? 

The Better U survey is currently designed to serve as a signal for how a team is functioning and how they experience their work within U of U Health. It is also created to be a conversation starter. Stress and burnout results should be reviewed within the context of the other Better U items as well as the open-ended responses. This combination of information should be enough for leaders to generate questions for an individual and/or team conversation as well as continuous improvement planning and intervention.  

For stress, leaders can inquire about the following: 

• Is the stress on our team manageable?  
• How do we work through the stress response cycle?  
• What stress injuries are present within our group and how do we respond to them? Are there ways they could be prevented? 
• What do we do when we experience overwhelm with our work? 
• Do we allow for breaks, have enough time to complete our work, use our vacation time, etc? 

For burnout, leaders can ask about the following: 

• What makes a good day at work? 
• When we are at our best, what does that look like? 
• What currently gets in the way of experiencing a good day at work or what frustrates you about work? 
• Given what gets in the way, what should we tackle first and what do you recommend for improvement? 

Ideally, these questions guide steps for continuous improvement and a continued team conversation. It is imperative that if leaders or a leadership team engage their group in a discussion that action follows. Also, it is imperative that if an employee discloses experiencing significant stress or burnout to a leader that their concerns are taken seriously. 

We all have a role in addressing stress and burnout in the workplace. As Dr. Christine Sinsky from the American Medical Association states, “While burnout manifests in individuals, it originates in systems.” Leaders can use their Better U survey data to better understand how stress and burnout impacts their team and then take appropriate action. That said, this is not a solitary endeavor. Leaders and teams can be supported by Human Resources, Organizational Development, the Resiliency Center, Faculty Development and other resources every step of the way.