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Brief history of ‘Burnout’

The British Medical Journal recently published an article discussing the history of ‘burnout’, stating that in (in the author’s opinion) healthcare professionals “have much to learn from established countermeasures in aviation”.

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5268 (Published 27 December 2018)Cite this as: BMJ 2018;363:k5268

I found this article interesting as it raised the idea of increasing complexity as a contributing factor to physician burnout. In complex systems, there are more and more interactions which can subtly influence the outcome.

If you consider the number of professionals a patient meets on admission to hospital, all of whom interact with one another sometimes directly, sometimes indirectly, the system, service, patient, technology and machinery group together to form a tangled web. Likewise, an individual professional in this system interacts with their work stream, technology, equipment and many other professionals, along hierarchies of responsibility and frequently with goal conflicts. It is easy to see how this could add to the mental exhaustion associated with burnout.
Human factors recognise that the workplace should be designed and organised to minimise the likelihood of error.

Systems thinking considers all of the dynamic interactions between people, task, technology and working conditions- the factors that often escape analysis. It then identifies the unsafe interactions and ways to alter or remove them. As systems thinking relies on more than actions by individuals it provides an opportunity for long term learning and lasting change.



Systems thinking is the type of analysis that enables us to design and organise our workplace to minimise error. It addresses complexity and may help to address the risk of burnout.

I have been privileged to visit the Air Traffic Control tower at Manchester Airport; it is quiet; peaceful (not the awkward silence of a library), the temperature is comfortable, the lighting is hardly noticeable, screens are clear, the control room is small but not crowded, the views are astounding, desks and seats are at an appropriate height. All who enter instinctively lower their voice; wait to be spoken to, we are the visitors, it is the controllers environment, but it is not intimidating, it does not diminish those who visit – it was incredibly calm.

To conclude, I think that Rajvinder Samra has a point; interventions to optimise performance should consider complexity at the individual, team and organisational level.

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