Introduction

This brief literature review discusses communication research related to the phenomenon of burnout [1]. The first section of the paper offers a definition of burnout and a brief chronological overview intended to set the stage for the second section of the paper, which reviews specific research on the additional role of social support in situations that frame burnout. In this review, research results imply that communication behaviors can mediate the process of burnout for human service providers and that investments in developing skills in using these behaviors are worthwhile. But not all results lead clearly in this direction as this review shows. The review ends with a discussion of the directions future research in communication might take given the gaps and trends noted in this literature review and recent changes in workplace environments. Burnout is an important area of study for multiple disciplines because it is costly in terms of loss of the full potential of human capability and in terms of real dollars lost to the derogatory results of burnout including loss of work time and low levels of productivity.

Definitions and A Chronological Overview of Burnout Research

Burnout is related to stress [2] and it is most frequently linked to three factors: (a) emotional exhaustion, (b) depersonalization related to the work environment, and (c) a sense of diminishing personal accomplishment. Outcomes of burnout in the workplace are generally linked to costly increases in turnover, absenteeism, and reduced productivity for the individual and the organization. These outcomes can also negatively affect the intended receiver of the services. Examining the role of communication in burnout is appropriate because communication is central in social interactions that take place when human service providers work with their clients and seek and give support within their workgroup and their larger organization. Communication can both contribute to burnout and be a possible solution to burnout.

Thirty years ago, the concept of burnout was first expressed by Herbert J. Freudenberger, Christina Maslach, and Ayala Pines (Farber, 1983). This was an age of social upheaval and strong social commitment, with many young individuals entering careers in human service professions. Freudenberger's (1974) description of burnout depicted idealistic young men and women who, while working harder and harder, sacrificing their own health in the process of meeting ideals larger than themselves, reaped few rewards for their efforts. Despite all their energetic, enthusiastic and earnest labor for the larger good, these human service workers often failed to make a difference in the lives of their clients. Researchers in the fields of social psychology, social work, anthropology, medicine, education, and communication continue to conduct research in burnout hoping to find relationships, patterns, and applications for both the personal and professional issues that affect workers in a variety of "helping" professions. Our knowledge base has grown and our social climate has changed since the early 1970s. As Cherniss (1980) predicted, the need for human service professionals continues to grow as our population ages and as responsibility for "helping" continues to shift from private social institutions such as churches to other public institutional forms of community-based support. Today, American workers in the human service professions, much like other American workers, are asked to do more and more with less and less, meet ambitious goals and objectives, account for better results using detailed numbers, and produce immediate successes. Farber (2000) points out that expressions of burnout now reflect today's work environment that includes: (a) the pressure of meeting the demands of others, (b) intense competition, (c) a drive to make money, and (d) a sense of being deprived of something that is deserved. Burnout in the community of human service providers may be taking this shape as well.

Human service providers are described as a population particularly vulnerable to burnout by Schaufeli, Maslach, and Marek (1993) because of the nature of the interpersonal processes in their work with clients and the organizational factors that generally accompany community-based social support organizations. Communication is an important element in the discussion of burnout, particularly in the areas of giving and receiving social support and maintaining a sense of community within the workplace between supervisor and subordinate and among co-workers.

Literature Review

The Maslach Burnout Inventory

Approximately 2500 books, journal articles, and dissertations were devoted to burnout during the period 1974-1990 (Maslach and Schaufeli, 1993). Included in this literature is discussion of the Maslach Burnout Inventory or MBI (Maslach and Jackson, 1982, 1986). The MBI is a short, easy to administer paper and pencil inventory. This measurement model presents burnout as a syndrome with three factors or dimensions: (a) emotional exhaustion, (b) depersonalization, and (c) diminished personal accomplishment. Emotional exhaustion is described as individuals who are experiencing stressors approaching, or beyond, their comfortable limits. Depersonalization is described as individuals who tend to distance self from others, who see people as things or objects. Personal accomplishment is defined as individuals who believe they are doing well on a job that is worth doing. This multidimensional model is not without critics of its structure (Garden, 1987), but is widely accepted and used in research concerning burnout. According to Maslach, burnout is composed of dynamic processes and systems including those that are important to social support and supportive communicative behaviors within a work group. The dynamic multidimensional nature of burnout may account for the volume of writing and research available for review.

Linking Social Support, Communication, and Burnout

Redding (1972) provided a holistic prescriptive model for organizational managers to follow in creating an ideal workplace that included (a) supportiveness; (b) participative decision-making; (c) trust, confidence, and credibility; (d) openness and candor in message sending and receiving; and (e) emphasis on performance goals. Social support emerges as a buffer to burnout and is strongly linked to communication systems. Social support is defined as "information that leads individuals to believe that they are cared for and loved, esteemed, and valued and that they participate in a network of communication and mutual obligation" (Cobb, 1976). Pines (1983) finds that the better the social support relationships, the less burnout. Pines and Aronson (1988) classify social support actions (supportive actions that mediate against burnout) into six categories based on extensive research with collaborative groups. The six functions of social support that emerged in their work include: (a) listening, (b) technical support, (c) technical challenge, (d) emotional support, (e) emotional challenge, and (f) sharing social reality. Their research reinforces the idea that people need effective support systems of dynamic communicative feedback to buffer the potential of burnout and that the systems are interactive in nature rather than one way social support mechanisms. These interactive sending and receiving systems of communication behaviors would include expressions of appreciation and reinforcement of the idea that success and positive growth comes with challenge. They also found that although these functions in social support systems can be named, they are underutilized. Farber (2000) emphasizes communication skills as coping skills. He recommends that as a buffer against burnout, we consciously help workers (a) clarify and adjust to the expectations of others, (b) focus on the positive aspects in work life, and (c) build strong social networks to mediate workplace stressors. Each of these coping skill recommendations can be translated into a variety of assertive communication behaviors that can be implemented in the workplace.

Related Research

Casey (1998) wanted to know to what extent and in which manner human service workers' use of normative organizational communication behaviors influence the experiences normally associated with burnout. Casey defines burnout as a unique form of chronic stress, and like Maslach (1982), she defines burnout as a process that leads to emotional exhaustion, depersonalization, and diminished personal accomplishment. She examined resource replacement strategies used by workers in forty-six community-based human service organizations. The specific communication replacement behavior strategies or actions Casey studies are (a) role modification, (b) feedback seeking, (c) reification of the meaningfulness of work (talk with co-workers and other professionals external to the workplace), and (d) social support seeking. Her examination of these strategies in relationship to workplace burnout revealed that communication replacement strategies are distinctive on the basis of the communication target (like a supervisor or co-worker), but not on the communication behavior. Casey also tested to determine if an individual's tolerance for ambiguity (lack of information or feedback) and personal control (influence) are strategic reserves that can moderate the process of burnout. Her findings indicate that the framework of conservation of resources (building or conserving resources) is not supported in the case of burnout. She speculates one reason may be that the human services environment differs from other environments in that burnout processes reflect unsuccessful adaptation rather than abrupt reactions that prompt sudden resource building or conservation actions. Because resource-building and conserving communication behaviors are the norm in the human service provider environment, it does not fit the strategic resource replacement framework Casey is testing. The study does imply that the quality of relationships with supervisors and co-workers is a critical element in a human service provider's decision to use or build resources. In particular, this study suggests that human service workers who have high quality relationships with their supervisors have greater access to and are more likely to access needed social support resources to cope with demands in the workplace.

Miller et al., (1990) also examine the workers' personal control and tolerance for ambiguity related to burnout as well as the role of social support in mediating uncertainty. Their results from a study conducted in a private psychiatric hospital indicate that both participation in decision-making (related to reduction of uncertainty) and receiving social support from supervisors and co-workers (related to social information processing) are important in a worker's perception of workplace stresses and burnout. They report findings from their research that indicate participation in decision-making is crucial in reducing role stress and increasing perceptions of satisfaction and personal accomplishment.

Cherniss (1980), who used interviews to study public human services professionals new to the workplace, finds "sources of strain" for these new professionals include: (a) mistrust, (b) organizational conflict, (c) rigid role structure, (d) isolating work practices, and (e) entrenched patterns of uncommunicative social interaction that link directly to communication behaviors in the workplace. These factors lead Cherniss to state that it is a "sense of helplessness in the face of failure that is the major contributor to burnout" (p. 78). Cherniss' research reveals that elusiveness of collegiality, professional isolation in the workplace, and lack of feedback are the norm rather than the exception (p. 91). In addition, the supervisor relationships with employees in his study were rarely warm, open, or supportive, and the social conditions of the work environment seemed to block supportive communication structures for the entire work population, veteran service providers and newcomers alike. Lewin (1951) emphasized the importance of social factors such as group membership and how different groups can influence an individual's behavior. In the case of Cherniss' study of human service professionals, the veteran population of providers conveyed a negative influence on the newcomer that virtually ensured the perpetuation of burnout for the entire group.

Leiter (1988) finds, like others (Maslach, 1982; Pines & Aronson, 1988), that demands in the work environment lead to emotional exhaustion, which then leads to feelings of depersonalization, but his research also reveals the complexities and contradictions that arise in the research about burnout by examining network role structure. In his 1988 examination of network role structure and the influence of network integration, Leiter finds that co-worker interactions can both ameliorate and exacerbate burnout. He finds that (a) a greater number of links with co-workers in the informal network was associated with increasing feelings of personal accomplishments, and (b) that a greater number of reciprocal links with co-workers in the work-related more formal network predicted increased feelings of personal accomplishment and also greater emotional exhaustion. Earlier, Leiter and Meechan (1986) reported that the more the informal network was concentrated within the formal network, the greater the emotional exhaustion and depersonalization for the individual. Leiter found increases in perception of supervisor support to be negatively correlated, showing a decrease in an individual's feelings of personal accomplishment when supervisor support is increased (Leiter, 1991). He speculates that the cause may be that the increase in supervisor support is an indicator of an environment that has already become threatening to the individual.

Golembiewski and Munzenrider (1988) addressed knowledge and burnout, building on the work of Maslach and Jackson (1982, 1986). They show that as information about results decrease, emotional exhaustion, depersonalization, and diminished personal accomplishment increase. Like the Maslach MBI instrument, the Golembiewski eight-phase model of burnout is well-validated. Golembiewski's model focuses on ways individuals experience whatever stressors they encounter, not just workplace stressors, for reasons explained by Golembieski, Boudreau, Sun, and Luo (1998): (a) individuals differ widely as to the number and intensity of stressors with which they can comfortably cope -- not only are there differences between people at any one time, but also at different points in time for any one person, and (b) a stressor can energize some people, while it herniates others. In the eight-phase model, Phase II is the high depersonalization phase which deprives individuals of information, increasing ambiguity and, over time, impeding work performance. Phase VIII, emotional exhaustion, Golembiewski describes as reaching a level of strain beyond the individual's comfortable coping capability. In this phase, research describes people who keep others distant, lack social support, and lack information. Research conducted in North America as well as in global settings using the eight-phase model illustrates the following changes in character and quality of life in organizations: (a) job involvement and all facets of job satisfaction decrease, (b) turnover increases, both in intent and in actual departures, (c) group cohesiveness decreases, (d) physical and emotional symptoms increase, (e) features of family life deteriorate, (f) indicators of performance fall, and (g) costs of medical insurance increase significantly. These findings apply to both the public and private sectors in North America, with private sector settings in North America including 40.9 percent of all respondents in Phases V, VII, and VIII compared with 44.1 percent for U.S. public-sector work sites and 41.8 percent for their Canadian counterparts. In addition, Golembiewski et al. (1998), imply that burnout distribution follows a pattern of contagiousness. In the Phase VI, VII, and VIII stage, over 87 percent occur in organizations having 40 to 60 percent of their employees in those three extreme phases. This research suggests that burnout can spread to individuals in an organization not previously affected and matches findings made by Cherniss (1980) who described burnout as "highly contagious" (p. 93).

Drawing prescriptions from their research, Golembiewski et al., (1998) suggest increased supervisor communication interventions that improve interactive communication support systems like using active listening skills and giving effective feedback. They advocate the development of a broad empirical theory similar to action theories that is goal-based and inclusive of those that are served, particularly in public agencies (Golembiewski,1997). In their view, organizational communication systems would include message sending and receiving and conscious coordination with clients as well co-workers and supervisors in the workplace setting.

This review acknowledges that many important studies have been ignored including those of Miller, Birkholt, Scott, and Stage (1995); Miller, Stiff, and Ellis (1988); Miller, Zook, and Ellis (1989); and Ray and Miller (1991), however, the few included here produce important findings. Those findings include classification of social support actions or functions into six categoriesPines and Aronson (1988), that building and conserving resources is not an effective hedge against burnout Casey (1998), that the quality of the relationships with supervisors leads to greater access to and use of social support resources (Casey, 1998), that participation in decision-making can reduce role stress and increase perceptions of satisfaction and personal accomplishment Miller, et al., (1990), and surprisingly to some, that co-worker interaction can both ameliorate and exacerbate burnout (Leiter (1998). Golembiewski et al., (1998) conducts research internationally that supports the view that message sending and receiving and conscious coordination with clients, co-workers, and supervisors provide hedges against burnout in both public and private sectors.

Directions for Future Research

As we try to anticipate what political, social, legal, environmental, technological, and other issues will surface in the future, we must heed Seibold's advice (Poole, Putnam, and Seibold, 1997). We need to trace how changes in work and the workplace affect organization communication and use the resulting applications from our research to demonstrate communicative activities that address societal changes. Directions for research suggested here include: (a) field research to examine communication and social support behaviors; (b) criteria development so that a scale for judging quantities of burnout can be standardized; and (c) investigations into the relationship of new communication technologies to burnout.

I recommend scholarly field research that collects, records, analyzes, and compares the communication and social support behaviors used by human service providers to balance the research conducted using largely self-report data gathering instruments like the MBI. Golembiewski (1997) advocates application of an action research approach to organizational health issues overall and burnout specifically. Longitudinal studies using field observation data collection techniques to record communication behaviors will convey the context and structure of the dynamic social support interactions in burnout. We need research about (a) how to calculate the cost of burnout, (b) the distribution of the phases of burnout, (c) the settings that are prone to advanced burnout, and (d) successful mediation devices for dealing with burnout. <<only the last of those seems especially communication based… Following the action science path of Lewin (1951) as well as paths laid out by Argyris and Schön (1974), communication behaviors that provide social support in burnout-prone community-based workplaces could lead to improved processes in organizations and guide development of training programs.

Still absent from the literature is the definitive objective criteria that identifies a scale and the point on the scale when behavior in social interactions can be diagnosed as burnout. Golembiewski et al. (1998), using Maslach and Jackson's MBI inventory, are moving toward scale development with the eight-phase model of burnout, but have yet to develop the values for comparison across global populations. Development of criteria to judge when burnout is individually and organizationally unhealthy (Casey, 1998) will help educators construct communication curricula that convey ways to identify and mediate burnout.

The emergence of new communication technologies invites study into the relationship between burnout and these new ways of communicating and forming organizational communication systems. Global communities as described by Maslach and Leiter (1997) are communities that develop through social interactions using email, video conferencing, and other communication technologies as forms of getting people together. The greater connectivity and participatory demands of the virtual community need to be documented, studied, and compared to existing models of burnout to reveal if, when, and how burnout occurs when using mediated communication tools. Is our increasing electronic interconnectedness contributing to burnout and social isolation, or is this connecting power producing unique and helpful communication behaviors that provide dynamic interactive social support systems (organizational communication systems) that mediate burnout?

Finally, research needs to take us further down the path that Weaver and Shannon [3] (1963), with their focus on mathematical definition of information, paved for us with a definition of information as reduction of uncertainty. These threads of study open up questions concerning digital libraries and the abundance of information that is intended to offer support to the health service provider. People are beginning to question how the availability of large amounts of information about community and health information contribute to burnout by producing a burdensome overload of support communication instead of the form of social support it was intended to provide. Research to find out how health services providers use community and health information resources to reduce uncertainty for themselves and their clients would inform designers of digital libraries and mediated communication support tools and help develop supportive and practical products. Based on findings in earlier studies researchers can more closely examine ways health service providers can recognize and fully use already existing social support mechanisms to prevent burnout.

[1] Extensive reviews of burnout literature are found in Maslach and Schaufeli (1993) and meta-analysis of the dimensions of burnout can be found in Lee and Ashforth (1996).

[2] Stress and burnout are not the same, but they are related. Burnout is addressed as a multidimensional process. The stress of burnout arises from the social interaction between the helper and the recipient or other demands of an interpersonal nature (Maslach, 1982). Other stressors may contribute such as work load and role stress that combines conflict and ambiguity ( Miller, Ellis, Zook, and Lyles, 1990).

[3] W. Weaver and C. E. Shannon, "A mathematical theory of communication," Bell System Technical Journal, vol. 27, pp. 379-423 and 623-656, July and October, 1948 is the original work. The University of Illinois has republished this work in later editions, the one referenced here includes a contribution by Warren Weaver and was published as a paperback in 1963.

References

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