Module 4 Outline: Situational (Physical and Environmental) Demands Contributing to Public Health Worker Burnout

In this module we explore the important influence of demands that are present when and where public health work is done. Specifically, we focus on demands that are linked to physical and environmental characteristics of public health work that are external to the person.
Our goal in this module is to help you recognize these types of demands and how they affect you and the people you supervise or manage.
This will be accomplished by exploring:
1. how it can be helpful to understand the physical and environmental demands that are present in our work situations
2. and how these types of demands can contribute to burnout.

It is often suggested or at least implied that burnout is a psychological condition – it develops from psychological causes and leads to psychological effects or consequences.
1. In other words, burnout is often seen as resulting mainly from how people perceive and respond to difficulties and challenges associated with their work.
2. There is an important psychological and social component to burnout (as we discuss in later modules).
3. Limiting consideration of burnout to psychological factors, however, makes people think of burnout as entirely internal and unique to each person.
4. This prevents us from understanding that other, more tangible, and often more controllable aspects of our work environments also seriously affect our bodies and minds. By controllable, we mean reasonably able to be managed or changed by the organization.
Burnout is influenced by and can have a real influence on numerous physical and environmental factors that exist in and around our work situations.
1. We refer to these external factors as situational demands.
We discuss more examples of physical and environmental demands found in public health work situations a bit later, but first a few overarching points need to be emphasized:
1. Burnout is a condition that generally results from chronic resource depletion. When physical and environmental demands chronically cause us to operate in a resource-depleted state, negative consequences arise. As we reviewed in Unit 1, these consequences can include detriments to personal well-being and costs to the organization, like lost productivity or turnover.
2. Many aspects of our working situations drain us of resources like physical energy and stamina. This leaves us in a high burnout risk state, where demands frequently exceed the resources we need to meet those demands.
3. Over time, chronically high levels of these types of demands also may become generally accepted as “par for the course” and normalized into very risky situational patterns and ways or rhythms of working. Examples include regularly working extended shifts, always working with too few staff members, or tackling job tasks without total compliance with personal protective equipment guidelines.
4. Decades of work-related stress research has examined and identified how such chronic exposures or demand loads in the absence of recovery lead to significant wear and tear on our physical and psychological systems over time (e.g., Brosschot et al., 2005; Juster et al., 2010).
For these reasons, burnout is not simply an internal, personal psychological experience. Factors “outside” the person play a big role.
With all of this in mind, preventing and resolving burnout should also not be left to the individual to figure out or attempt to manage on their own.
1. As we discuss in later modules of this training, addressing physical and environmental demands often requires changes at multiple levels within public health organizations and work settings. This includes group-, leader-, and organization-level intervention efforts.

Our focus in this module is on physical and environmental demands that arise in public health work situations.
In general, recall that demands are events, circumstances, or pressures to which we need to respond.
1. Physical demands are those that place a burden directly on our body’s physical systems
2. Environmental demands are characteristics and conditions of the broader work environment that place a burden on us, typically in physical ways (but not always)
3. Together, physical and environmental demands make up the more general class of situational demands that we experience while work.
4. Note that each public health role may have at least partially unique situational (that is, physical and environmental) demands
Although public health work may not always be seen by the general public as physically or environmentally difficult, many public health situations impose very real physical and environmental demands.
The following are illustrations of common and influential situational and environmental demands affecting public health workers. We pulled these from our interviews with public health professionals, a recent health advisory from the U.S. Office of the Surgeon General (2022), and publicly available data about public health work in the U.S. Department of Labor’s Occupational Information Network (O*NET).
1. Physical demands that may be most relevant for public health workers in an office setting may be:
  1. Repetitive motions, which can include typing and computer work
  2. Limited opportunities for movement for those who have to sit for long periods of time
2. Other physical demands that can more broadly contribute to burnout and may be experienced more by public health workers in field settings could include:
  1. Heavy lifting
  2. Excessive standing
  3. A crisis or trauma-inducing event that could include physical or emotional harm
  4. Frequent face-to-face and close physical contact
3. Environmental demands that may be most familiar to public health workers can be…
  1. Work scheduling and staffing limitations
  2. High-distraction or poorly designed workspaces
4. But environmental demands can occur in field settings or even buildings that are older or not well-maintained. These environmental stressors can be…
  1. Uncontrollable noise or general stimulation (too much or too little)
  2. Poor air quality (including presence of toxins, viruses, bacteria, etc.)
  3. Temperature extremes
  4. Inadequate or overly intense lighting conditions, glare from computer screens
Some demands of this form are pretty “visible” or relatively easy to observe or identify. Examples include lifting or standing requirements, exposure to noise or fumes, and direct interaction with the public to administer vaccines.
Other demands of this form may be essentially “invisible” or hidden. Examples include poor air quality, repetitive motions, awkward postures, and exposure to mechanical vibrations.
Physical and environmental demands come at us from all directions in our work situations and, as a result, are very difficult to ignore or fully control.
1. Physical and environmental demands also tend to affect us even when we are not fully aware of them. This is in contrast to most psychological and social demands, discussed elsewhere in this training series, which typically need to be perceived and appraised before they can trigger stress reactions.
2. Exposure to physical and environmental demands leads to stress and ultimately strains like burnout when our ability to respond to these demands is limited or hindered by a lack of corresponding resources. This is unfortunately the case for workers who are exposed to complex physical and environmental demands.
Situational demands differ from more personal (i.e., psychological and social) demands, which we will discuss in Module 5 of this training.
1. The impact of personal demands is at least partially determined by how people perceive, evaluate, and choose to respond to those demands.
2. In contrast, many physical and environmental demands experienced in work situations may readily trigger stress in workers due to direct effects on our bodies.
3. As a quick example, interacting with a coworker who is in a bad mood may or may not trigger a stress reaction; working for several hours in an excessively noisy or extremely cold situation will.

In the work we do as industrial and organizational psychologists, we help organizations recruit, select, and place people into the “best-fitting” positions possible.
1. The challenge for us and all leaders, managers, and supervisors is that we need to try to fit the jobs that need doing to actual people through better job and work design, accommodations where necessary, and by more generally ensuring workers have access to the resources they need to meet situational demands while working.
2. We work to do this so as to maximize the likelihood that each individual is able to perform well and therefore create as much value as possible for the organization.
3. A secondary goal that is at least as important, is to ensure people fit their work situations. When this is achieved, people are more likely to stay safe and healthy, and to experience high levels of well-being.
4. These concepts are supported by research and linked to influential theories of person-environment fit (e.g., Caplan, 1987) and person-organization fit (e.g., Chatman, 1989), among others. The basis of these theories is that when the traits, abilities, skills, and/or preferences of an individual match their organization or work environment, better outcomes result.
Achieving this type of alignment between workers and their work situations is an ongoing and multidirectional process involving individual workers and the employing organizations.
1. The importance of person-environment fit is well-established (e.g., Canter & Craik, 1981; Leather et al., 2010), but impossible to achieve without consideration and attention paid to specific types of situational and environmental demands, including generally sensory stimulation, social stimulation, and movement (Wohlwill, 1974).
2. A couple of quick examples of person-environment misfit at work are when workers experience over-stimulation (e.g., too much noise, too many distractions, or too much movement) or under-stimulation, which often accompanies boredom and isolation at work. Both are bad for worker productivity and well-being.

Public health managers and supervisors can play a big role in helping workers manage situational demands at work:
1. Situational demands often result, at least in part, from leader/manager/supervisor decisions. This includes decisions that affect work design, work assignments, and work-related resource availability.
  1. Changes to control, reduce, or remove these types of demands require the involvement of leaders/managers/supervisors and the overall organization. In other words, it is often not feasible or “right” to expect workers to find their own ways to manage these types of demands.
  2. The reason for this is that situational demands are “baked into” the work that individuals must do. It makes no more sense to expect individual workers to somehow control these types of demands than it makes for organizations to somehow control workers’ bedtime routines to combat fatigue.
2. Second, the resources workers need to address situational demands, like environmental controls, special equipment, or schedule control, are often controlled by leaders/managers/supervisors. Resources will be discussed in later modules of this training.
3. Third, managers and supervisors are often in positions to notice workers struggling to address situational demands. Keeping an eye on each other is an important element to any strategy to control burnout risks in work situations.
  1. This is particularly true because burnout does not develop overnight, but rather slowly over time. Situational demands that chronically exceed available resources can lead to overexertion and feelings of inefficacy. Collectively, these experiences are core elements to serious strain states such as burnout.

1. 1. There are many physical and environmental demands, like the ones we examined in this module, that are deeply connected to the situations in which public health work is done.
  2. Physical and environmental demands tend to affect all or most workers in relatively consistent ways, requiring adaptive responses that typically need to address the demand itself, rather than the way an individual might perceive a demand.
  3. Many of the situational demands we highlighted in this module, like scheduling control, staffing levels, and information limitations, are not well-understood or consistently regulated by government or industry standards.
  4. As an important reminder, burnout risk is not reduced only by minimizing exposures to or the presence of demands.
    1. Leaders/managers/supervisors also need to make an active effort to ensure that workers have access to the resources they need to address these demands when they are present.
    2. Many physical and environmental demands like the ones we have been discussing will be present no matter how many controls are put into place.
  5. With this in mind, interventions to address physical and environmental demands need to happen at levels other than the individual worker. Most workers (especially public health workers) do not have much control over these situational demands and the resources needed to address them.
    1. We also acknowledge that many leaders with great intentions may also feel helpless at times. Organizational structures can sometimes leave leaders feeling powerless. But we hope you can find at least a few suggestions from this module that you can implement to help reduce demands your workers face. Or, at the very least, we hope you feel more equipped to advocate to your leaders for the resources you need to address these critical demands at work.
  6. Here is a quick reminder of the other content covered in this training course. We hope you are finding this information to be helpful and that you will take the time to review additional modules.

References

Brosschot, J. F., Pieper, S., & Thayer, J. F. (2005). Expanding stress theory: prolonged activation and perseverative cognition. Psychoneuroendocrinology, 30, 1043-1049. https://doi.org/10.1016/j.psyneuen.2005.04.008

Canter, D. V., & Craik, K. H. (1981). Environmental psychology. Journal of Environmental Psychology, 1, 1-11. https://doi.org/10.1016/S0272-4944(81)80013-8

Caplan, R. D. (1987). Person-environment fit theory and organizations: commensurate dimensions, time perspectives, and mechanism. Journal of Vocational Behavior, 31, 248-267. https://doi.org/10.1016/0001-8791(87)90042-X

Chatman, J. A. (1989). Improving Interactional Organizational Research – a Model of Person-Organization Fit. Academy of Management Review, 14, 333-349. https://doi.org/10.2307/258171

Juster, R. P., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews, 35(1), 2-16. https://doi.org/10.1016/j.neubiorev.2009.10.002

Leather, P., Zarola, T., & Santos, A. (2010). The physical workplace: An OHP perspective. In S. Leka & J. Houdmont (Eds.), Occupational health psychology (pp. 225-249). Blackwell Publishing, Ltd.

U.S. Department of Labor, Employment and Training Administration. (2022). Occupational Information Network (O*NET) Online. https://www.onetonline.org/

U.S. Office of the Surgeon General (2022). Addressing health worker burnout: The U.S. Surgeon General’s advisory on building a thriving health workforce. https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html

Wohlwill, J. F. (1974). Human adaptation to levels of environmental stimulation. Human Ecology, 2(2), 127-147. https://doi.org/10.1007/BF01558117

Module 4 Outline: Situational (Physical and Environmental) Demands Contributing to Public Health Worker Burnout

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