What works to alleviate frontline worker burnout?

Together, the What Works Centre for Wellbeing and the Centre for Homelessness Impact are exploring what works to improve the wellbeing of frontline workers in the homelessness sector.

The project aims to:

1. map the global landscape of behavioural interventions aimed at reducing burnout among frontline workers through a literature review;

2. design light-touch behavioural interventions to alleviate burnout among frontline homelessness sector workers in the UK.

This document summarises outputs from the first aim.

By reviewing the existing literature, we found evidence:

• That a range of individual-level psychological and social interventions may be effective in reducing burnout among frontline staff;

• Of potential moderators of workplace burnout.

No evidence specifically on homelessness sector frontline worker burnout was found.

The insights can be used to shape further research and policy making, as well as guide funding decisions and practitioner activity.

In the UK, heavy workloads and stress are the leading causes of short and long absence at work.¹CIPD (2023). Health and Wellbeing at Work: Survey Report. September 2023.

In frontline roles – for example client-facing charity workers – workloads can be particularly challenging due to increasing caseloads and prolonged exposure to high-stress situations. This makes these groups particularly vulnerable to burnout, and can limit the effectiveness of the support they provide.²St. Martin in the Fields. (March 2023). Frontline Worker Survey 2022: Experiences of Frontline homelessness work. Report on staff working conditions, training and professional development, wellbeing and job retention.

What is Burnout?

The World Health Organization defines burnout as an occupational phenomenon “resulting from chronic workplace stress that has not been successfully managed”. It typically includes feelings of exhaustion or energy depletion, feelings of negativity, cynicism, and a reduction in professional efficacy³3 World Health Organization. (2019, 28 May). Burn-out an “occupational phenomenon”: International Classification of Diseases., and is linked to low wellbeing.⁴Salvagioni D.A.J., Melanda F.N., Mesas A.E., Gonzalez A.D., Gabani F.L., Andrade S.M.d. (2017) Physical, psychological and occupational consequences of job burnout: A systematic review of prospective studies. PloS ONE 12(10): e0185781.

Addressing burnout is a key priority to ensure staff wellbeing and broader organisational performance.

What are burnout interventions?

While interventions targeting burnout can vary significantly in content, they tend to:

1. target individuals rather than organisations;
2. aim to increase personal psychological and social resources to improve coping mechanisms.⁵Schaufeli, W., & Enzmann, D. (1998). The Burnout Companion To Study And Practice: A Critical Analysis (1st ed.). CRC Press.

Evaluation of their effectiveness appears to be limited by the overall lack of consensus on the definition and assessment of burnout.⁶Ahola, K., Toppinen-Tanner, S., & Seppänen, J. (2017). Interventions to alleviate burnout symptoms and to support return to work among employees with burnout: Systematic review and meta-analysis. Burnout Research, 4, 1–11.

In this project, we look at light-touch or non-intensive behavioural interventions that use strategies such as reminders, warnings, and simplification to alter people’s behaviour.⁷UN Innovation Network United Nations Behavioural Science Report. [(accessed on 1 December 2022)].

What we did

We searched for primary studies that:

2. Measure the effectiveness of a workplace burnout intervention using an experimental or quasi-experimental design;
3. Capture changes in burnout quantitatively using any standardised measure of burnout.

To be included, studies had to be:

• of interventions clearly aimed at alleviating or reducing risk of burnout among frontline staff;
• publicly available;
• published in English.

More information on the search strategy and study inclusion criteria adopted can be found in the methodology section of the technical report.

The literature review found 33 studies on the effectiveness of workplace burnout interventions. These were pooled by three key themes:

1. Psychological – including psychoeducational, psychosocial, and therapeutic interventions;
2. Social support interventions;
3. Capture changes in burnout quantitatively using any standardised measure of burnout.

The studies were found were:

• Largely of in-person intensive behavioural interventions that were aimed at alleviating burnout among healthcare sector workers;
• Published from 2007 onward;
• Capturing burnout using one of eight validated measures, most commonly, the Maslach Burnout Inventory (MBI).
• Delivered primarily in Europe (42%), the United States (36%) and Asia (18%).

Comprehensive findings are detailed in the full report. Here we highlight key insights.

Intervention effectiveness

Experimental findings from this review suggest that a range of interventions may be effective in reducing burnout among frontline staff, in particular, within the healthcare sector. It found no evidence of evaluation in the homeless sector setting.

Of the 33 studies identified, 21 reported statistically significant reductions in burnout compared to control groups.

Effective interventions include:

• Psychoeducational – including educational modules to develop resilience, social and emotional skills, empowerment, self-care, self-efficacy and social support. 
• Therapeutic – involving Acceptance and Commitment Therapy (ACT), mindfulness, compassion, acupressure, emotional freedom techniques, and resilience-based theory.
• Psychosocial – including group skills training programmes to develop communication and problem-solving skills, participatory workshops to improve organisational processes and strengthen team working, and interventions to bolster social support and belonging between employees (1 study).
• In-person social support interventions – which included a team-based support group targeting healthcare providers in the Netherlands.
• Other – including:
  – laughter yoga delivered to nurses in Turkey,
  – an intervention to alleviate stress among primary care physicians (1 intervention)
  – improving care pathways and strengthening team-working in acute hospital settings.

Potential moderators of burnout

Studies also shed light on the following factors that may be contributing to improvements:

• Psychological resources – such as emotional regulation;
• Social resources such as social connection and a sense of belonging;
• Job characteristics such as workload, team-working and participation in decision-making.

Our review highlights gaps in the evidence relating to:

Randomised controlled trials are regarded as the gold standard for evaluating the effectiveness of interventions by providing causal evidence.

The next steps of this project will be the design and implementation of a RCT in 2024 that will test what works to reduce burnout in frontline workers in the homelessness sector.

Suggested citation

Musella, M., Quinzá, M., Bignall-Donnelly, R. (January 2024) What works to alleviate frontline worker burnout? What Works Centre for Wellbeing