Occupational burn-out and purpose-driven organisations.

Around your work have you ever had feelings of energy depletion or exhaustion, a distancing from it that has included negativism or cynicism towards work, and a resulting reduced professional effectiveness? If so then you’ve probably suffered to some degree from occupational burn-out, for these are the dimensions to burn-out that were set-down by the World Health Organization (WHO, 2019) in the eleventh International Classification of Diseases (ICD-11).^[I] And, although this ‘occupational phenomenon’ is not classified by the WHO as a medical condition, it is clearly described as ‘a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed’. Indeed, I believe that in pointing to the origins of this burn-out that the key part in this phrase for organisations and organisational leaders are the words: ‘workplace stress that has not been successfully managed’. As it raises both a personal and social responsibility of care towards an organisation’s staff and, which in terms of organisational effectiveness or litigation, raises potential organisational threats.

Inclusion in ICD-11 represents an important milestone in the recognition of the mental health impact that poor working practices can have on workers. Furthermore, that these aspects of occupational burn-out are currently being used by WHO to develop evidence-based guidelines on mental well-being in the workplace, raises the importance of this mental health issue for all organisations. Certainly, for non-profits – many of whom operate in high-stress, low-resource environments or work with a mission-driven pressure to perform – this is a tangible human resource concern.

Thus, the aim of this think-piece is to serve as a primer for organisational leaders and in it I highlight the main issues that they should consider with regard to occupational burn-out. What is it, what are its impacts, what seems to cause it, and what can be done to prevent it? These are covered in the following four sections:

The Magnitude of Work Burn-out.
Causes of Occupational Burn-out.
Addressing the Causes of Burn-out.
Concluding Remarks for Non-profits.

The Magnitude of Work Burn-out

‘employee burnout can trigger a downward spiral in individual and organizational performance.’
(Wigert & Agrawal, 2018a)

Natalie Matranga, in her article: Burnout as human rights worker and how to tackle it^[ii], points out how ‘it is important to be able to recognise symptoms of burnout, both so that we can acknowledge when we experience it ourselves, and so that we can see signs of burnout in our colleagues and help them to find support.’ She goes on to list some of the common symptoms of burn-out, mirroring much of what the WHO has identified:

‘Losing enthusiasm for your job, and even dreading going to work.
A loss of job satisfaction or a feeling of disillusionment in your career.
Feeling low in energy and not enjoying the things that used to give you pleasure.
Getting easily irritated, angry or upset.
Insomnia.
Change in appetite.
Trying to ignore your feelings by abusing or misusing drugs or alcohol.
Feeling distant from family and friends and trying to isolate yourself from social situations.’ (Matranga, n.d.)

And yet ‘for decades, the term “burnout” has been deprioritized — wrongly accused of being some made-up, first-world crisis, most likely drummed up by millennials and Gen Zers who want more work-life balance’ (Moss, 2019). However, when the dimensions and the effects of burn-out are considered, organisational leaders ignore it at their peril: ‘A recent Gallup study of nearly 7,500 full-time employees found that 23% of employees reported feeling burned out at work very often or always, while an additional 44% reported feeling burned out sometimes’ (Wigert & Agrawal, 2018a).^[iii] Take a second to take that in, that means two-thirds of us at some time will experience burn-out caused by our work.

In the civil society sphere, where the weight of purpose- or mission-driven aims lends an additional dimension, the frequency of work-sourced mental health issues is even more pronounced: ‘A 2015 survey by The Guardian reported that 79% of the 754 aid workers interviewed reported suffering from some kind of mental illness; of those, 93% said that the condition was work related. In a separate survey of human rights workers, 19% appeared to be suffering from Post-Traumatic Stress Disorder (PTSD) – figures that are similar to levels of PTSD suffered by combat veterans and emergency first responders’ (Matranga, n.d.). Given that 73% of those aid workers surveyed reported work-related mental health issues, this surely represents an epidemic of workplace stress and anxiety in the sector.

Indeed, Jennifer Moss, in a Harvard Business Review article: When passion leads to burnout (2019)^[iv], observed that: ‘While burnout can affect anyone, at any age, in any industry, it’s important to note that there are certain sectors and roles that are at increased risk, and purpose-driven work — that is work people love and feel passionately about — is one of them. According to a study published in the Journal of Personality, this type of labor can breed obsessive — versus harmonious — passion, which predicts an increase of conflict, and thus burnout.’ Supporting that observation, a recent study by Yale University (see Seppälä and Moeller, 1 in 5 Employees Is Highly Engaged and at Risk of Burnout, 2019) has ‘cast doubts on the idea of engagement as a purely beneficial experience’. ‘The data shows that one in five employees reported both high engagement and high burnout’ (engaged-exhausted). ‘These engaged-exhausted workers were passionate about their work, but also had intensely mixed feelings about it’. And they also exhibited the highest turnover.

From my work with non-profits I’ve recognised how there is often a grin and bear it attitude, as committed activists fight for their causes in a resource-strapped reality. This can morph into an expectation that NGO staff must, by the very nature of their work, be under constant stress. Sometimes this develops into what I characterise as a ‘badge of honour‘ culture of struggle and which effectively represents a form of self-harm.^[v] Indeed, I recall performing an organisational review with a team of campaigners in an advocacy group and how, when they started to confide their feelings on their work overload, several of them expressed how they were “working too much and do too much”. They went on to say “[we need] external help to cut down ambitions [of the] too many campaigns”, or related how they had “too much work, too few people”, and which they connected to their feelings of being “drained” and in “low spirits”. Certainly, the feelings of disillusionment or cynicism given in the WHO classification of occupational burn-out were evident across these conversations.

Furthermore, while these staff clearly identified with and were committed to the organisation and its aims, there also appeared to be a general uneasiness over the impact of what they were doing: “We should focus on less issues, we are so very broad Robert. [There is a] strong case for working on less issues and having more impact on fewer things. If we were able to narrow down, we would feel more satisfaction on what we are doing and doing it really well.” One person said: “[we need to] be more consistent that knowing that the things we are doing are reinforcing our core values. How does it all fit together?” Another told me: “often success is about the activity and not about the impact. Success is about a meeting not about what it means; [the activity is] celebrated more than the outcome.”

To me it is clear that: ‘…the hard organizational cost of burnout is substantial: Burned-out employees are 63% more likely to take a sick day and 2.6 times as likely to be actively seeking a different job’ and ‘even scarier, burned-out employees are 23% more likely to visit the emergency room’ (Wigert & Agrawal, 2018a). Indeed, I believe these figures, coupled with such personal testimonies, highlight how health and safety issues must extend beyond the traditional focus on physical working conditions, to encompass a consideration of the human impact of working culture and approaches.

The Causes of Occupational Burn-out

‘The main factors that cause employee burnout have less to do with expectations for hard work and high performance — and more to do with how someone is managed.’
(Wigert & Agrawal, 2018a)

A first step for organisational leaders, managers and workers is to understand better the origins of occupational burn-out. To identify what, in the way that we work, leads to this state of affairs and what then we might do about it? To begin to answer the first of these questions Wigert and Agrawal, for Gallup, have helpfully framed the root causes of burn-out: ‘There is little doubt that employee burnout is a symptom of a modern workplace that is increasingly fast-paced, complex and demanding more of employees. Technology — especially mobile technology — has blurred the lines between home life and work life. Flexibility is now the watchword’ (Wigert & Agrawal, 2018c).^[vi]

Leka and Jain (2017) have noted how there is a ‘…large body of academic literature demonstrating a range of work-based risk factors for mental health, including job strain, psychological demands, job control, social support, organisational justice, perceived job dissatisfaction, organisational change, job insecurity and employment status.’ Quoting another study they reveal that: ‘Three broad categories of work-related factors were identified to explain how work may contribute to the development of depression and/or anxiety: imbalanced job design, occupational uncertainty, and lack of value and respect in the workplace.’ Furthermore, within them: ‘…there was moderate level evidence … that high job demands, low job control, high effort-reward imbalance, low relational justice, low procedural justice, role stress, bullying and low social support in the workplace are associated with a greater risk of developing common mental health problems’ (Leka & Jain, 2017).

Building out from this I brought together what WHO (2019) and Gallup studies (Wigert & Agrawal, 2018a) have highlighted as the most common workplace risks to mental health. Perhaps take a minute now to run through these and consider, critically, your own workplace and working experience. How would you rate your organisation’s working practices and culture? What resonates in this list, what rankles, what could be changed?

Poor communication from management.
Limited participation in decision-making or low control over one’s area of work.
Low levels of support for employees from management.
Unmanageable workloads/unreasonable time pressures.
Unfair/unequal treatment at work.
Unclear/weakly defined roles, tasks or organisational objectives.
Inflexible working hours.
Inadequate health and safety policies.

This list covers a whole gamut of organisational areas, but importantly, I think, this list highlights a perhaps rather inconvenient organisational truth. And that is that the responsibility for ameliorating all these risks and factors clearly falls squarely of the shoulders of organisational managers and leaders. They are the ones who have the remit, and therefore also the power, to determine whether these risks to mental health, and that produce the conditions for burn-out, are addressed or not.

Indeed, I believe that it raises questions towards the very assumptions and values of how an organisation operates and the resulting role of managers and leaders in setting the organisational tone. As Wigert & Agrawal (2018b)^[vii] say ‘…a crucial element in whether or not workers experience burnout on the job is how managers treat their employees’. Thus, with managers acting as role-models, as the organisational metronomes, they are the ones really setting the expectations coming from an organisation’s working culture and their actions speak louder than any memo.

This is a challenge to managers, and it is perhaps an uncomfortable one, but importantly it does mean that something can be done by them to help set the right tone: ‘You can prevent — and reverse — burnout by changing how you manage and lead your employees. If you don’t address the true causes of employee burnout in your organization, you won’t have a workplace environment that empowers employees to feel and perform their best’ (Wigert & Agrawal, 2018a). The key point here is that there needs to be the willingness among organisational leaders (both at governance and management levels) to give due attention to their culture-defining impact.

Likewise, it is also important to realise how managers themselves are equally susceptible to burn-out: ‘Managers are just as likely, if not slightly more so, to suffer frequent or constant burnout than individual contributors (26% of managers vs. 24% of individual contributors). Managers are people, too, and they have the same fundamental human needs as individual contributors: the need to be heard, to feel like they are part of a team, to know they matter, to contribute meaningfully, and to learn and grow’ (Wigert & Agrawal, 2018b). Thus, this further indicates to me that a whole organisational approach must be considered.

In the third-sector, with its purpose-driven environment and usually a highly-engaged workforce, there are additional risks to consider when realising the drivers of occupational burn-out. Seppälä and Moeller (2018)^[viii], as mentioned above, have pointed out, the dangers of high-engagement. But, Jennifer Moss (2019) is more explicit in noting this purpose-sourced driver of burn-out: ‘…despite the clear benefits of feeling meaningfully connected to your work, … data suggests that there are often real and undiscussed complications of purpose-driven work on employees’ health that can be related to the experience of burnout long-term.’

Such levels of personal engagement and purpose, that can often lead to burn-out, and the organisational behaviours that might encourage, demand or model them, really need to be better recognised in the non-profit world. Furthermore, as I show below, they have to be addressed in ways that don’t simply shift the onus of providing the solution onto staff members alone. Indeed, criticism has been levelled at the frequent emphasis on resilience training, where: ‘…a focus on resilience, while important, should not distract from prevention efforts that involve creating environments that are more supportive of mental health by reducing risk factors in the work environment’ (Leka & Jain, 2017).

Addressing the Causes of Burn-out?

‘…leaders may want to “ditch the ’R’ word” — resilient — because it suggests that individuals should be able to avoid or recover from burnout on their own.’
(Moss, 2019)

So, what can be done, organisationally, to react to this apparent epidemic of work induced burn-out? Unfortunately, owing to the composite and complex nature of the factors involved, the answers are not so straight-forward. In a study by Stavroula Leka and Aditya Jain for the European Union: Mental Health in the Workplace in Europe, 2017^[ix], the authors highlight the complexity required to understand where interventions can be most effective. Assessing whether those that target the ‘organisational,’ ‘task/job level’ or ‘individual orientations’ show more promise?

Before going into possible practices or approaches it is worth taking a detailed look at some of Leka and Jain’s headline conclusions of what works and what doesn’t. From a variety of meta-studies, they made the following important deductions (underlining is my emphasis):

‘Successful programmes offered organizational leadership, health risk screening, individually tailored programmes, and a supportive workplace culture. … [highlighting] that various types of interventions, directed both at the organisational and at the individual level, led to positive outcomes.’
‘Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously.’
‘…very few interventions addressed aspects of the environment that might reduce the stress load (and thus the need for coping strategies) on individuals.’
‘…trials of workplace interventions to reduce stress showed small but positive outcomes of person-directed programmes. For example, there was reasonable evidence that staff training and workshops can be effective for preventing symptoms of burnout. These might include stress awareness courses with a focus on coping.’
‘Mindfulness based interventions cited in one systematic review were found to be effective for reducing negative psychological effects of the working environment. However, there was little evidence to suggest that this intervention was any more effective than other stress management approaches such as relaxation. Overall there was only moderate evidence that individually oriented interventions produce positive results in relation to burnout and stress prevention in workplaces.’
‘…one review suggested that organisationally focused interventions produced longer-lasting positive effects than those individually oriented. …the evidence suggests that modifications to aspects of the organisation’s culture and working practices should be considered in addition to those delivered at the individual level to create stronger effects in relation to burnout prevention. Alterations to workload or changes to working practices were demonstrated to reduce stressors and factors that can lead to burnout. Where managerial involvement and support for these interventions were found, there was a greater likelihood of positive effects.’
‘…while attempting to modify known work-based risk factors makes theoretical sense, in practice such activities require substantial cooperation from employers, who will need to balance the economic costs of changing the way their organisations operate against the potential benefits for their employees. In practice, the meta-review demonstrates that many workplaces have opted for attempting to enhance their workers’ resilience rather than modifying risk factors.’
‘…many of the more popular approaches to stress management, such as counselling, have limited evidence base in terms of efficacy. In contrast, CBT-based stress management interventions produced substantial benefits in terms of symptom reduction, but this did not translate to notable improvements in work-related outcomes such as absenteeism and productivity.’

To summarise, these research outcomes rather tend to question the efficacy of the individual focus of many workplace well-being programmes. In particular, those with an emphasis on individually orientated interventions that shift the responsibility for sustaining mental health in the face of prevalent work conditions from the organisation to the workers.

Leka and Jain concede that: ‘Further research is necessary to examine interventions addressing risk factors in the work environment (for example, promoting a positive and supportive organisational culture and organisational justice, increasing employee control and participation, introducing teamwork where appropriate) in combination with interventions at the individual level (for example, cognitive-behavioural therapy, physical activity and problem-focused return-to-work programmes). Yet, despite this caveat, they have said that ‘…amongst preventive interventions, multimodal approaches utilizing more than one technique simultaneously, tended to produce better results.’ Thus, this ‘…evidence adds to the need [to] address risk factors in terms of working conditions and work design to develop healthy work environments that will prevent the onset of mental ill health.’ The crucial point being that ‘…interventions in the workplace should address work environment risk factors and not only individual employee characteristics and behaviours.’

Indeed, Endeavour’s inquiries into Workplace Flourishing, and our promotion of the idea of the Enriching Organisation, would appear to support this conclusion. That an overall, or holistic, view of how an organisation’s operations impact on its staff/stakeholders is really required. Fundamentally I believe that any organisation that would put the needs of its staff to the fore (through supportive organising principles, approaches, practices and the norms that it promotes) would have a tendency to ameliorate the risks for occupational burn-out (https://endeavour.consulting/flourishing/).

At the very least, I would expect that any organisation would need to act along three lines to address issues of occupational burn-out:

Institutionalise ATTENTION to it, such as awareness raising among staff and leaders, and make an active assessment of the potential for burn-out (for one example see the Maslach Burnout Inventory^[x]).
Promote a supervisory ATTITUDE that seeks to limit the organisational causes of burn-out.
Put into place organisational ACTIONS or procedures, with help from mental health professionals, to deal with occupational burn-out.

Here I have brought together a list of workplace interventions that are suggested by others as ways to address occupational burn-out (WHO, 2019; Wigert & Agrawal, 2018b & c, Matranga, n.d.). It is a bit rough and ready, but, following the WHO’s three-pronged mental health support approach^[xi]^[xii], I feel it provides some guidance for organisational leaders on what should be considered and may be utilised as a rudimentary checklist:

1). Protect mental health by reducing work–related risk factors	Implement and enforce sector-appropriate health and safety policies and practices. Including risk assessments. Make sure everyone’s opinion counts. Ensure the genuine involvement of employees in decision-making. Conveying a feeling of control, consultation and participation helps (consult widely and actually listen to what comes back). Enact organisational practices that support a healthy work-life balance. This includes supervisors that are open to listen to work-life related problems; it is a part of their profile. Place performance expectations and metrics within employees’ control. Ensure the development of targets is a truly co-operative effort and resist an overtly top-down approach. Discourage stretch-targets. Recognise and reward the contribution of employees fairly. Be open about compensation approaches and assumptions. Provide working spaces that are safe, inviting and support collaborative efforts. Reduce noise and interruptions, have good equipment and systems, and audit lighting and air quality.
2). Promote mental health by developing the positive aspects of work and the strengths of employees	Make work purposeful. Show how all employees’ work is useful and has a wider value to organisational mission. Look to link what is done day-to-day to this purpose. Discuss the deeper purposes widely and ensure organisational values are actually used and adhered to in daily decision-making. Design all jobs to allow for autonomy; ensuring employee flexibility and control over how work gets done. Creating the appropriate job autonomy and flexibility should be part of every conversation about role design. Design and support effective and positive teamwork. Truly collaborative efforts tend to be supportive experiences and should be encouraged. Buddy-systems, mentor networks or other peer support systems can help create a supportive working environment and are particularly useful in the field where workers might feel particularly isolated. Managers need to model teamwork best practices. Focus on strengths-based feedback and development. Put in place a programme of career development and learning for employees.
3). Address mental health problems regardless of cause	Actively inform staff that mental health support is available. Put in place appropriate support programmes and initiatives. Wellness programmes have been used, through exercise and self-care, to help to deal with feelings of anxiety; although as shown above they should not stand alone. Identify and measure workplace distress, the harmful use of psychoactive substances and illness and provide resources to manage them. Staff are trained so that they know how to react to a colleague showing signs of burnout (there is training available for Mental Health First Aiders).

Concluding Remarks for Non-Profits

‘…when you get leaders to behave differently, it sends a signal to the rest of the organization that they can behave differently, too.’
(Schulte, 2018)

Matranga writes, ‘It is a positive sign that more and more organisations are developing policies regarding the welfare of their employees and taking steps to ensure that there are support services available.’ However, for many under-resourced, non-profits the options available to deal with employee burn-out can appear limited. Furthermore, while a lack of resources is a problem that can be addressed by more donor support and provision of programmes to attend to occupational burn-out (and which is sorely needed). I do worry that that could focus attention on attending to the symptoms of burn-out coming from external factors, rather than addressing systemic organisational causes.

Certainly, the research above (Leka & Jain, 2017) implies that there should rather be more stress placed on reducing the risk factors in terms of working conditions and work design. And, by returning to my experiences of organisations where their espoused values were not matched in their day-to-day practices, I believe there needs to be a heightened emphasis on the development of a healthy and supportive organisational culture. Thus (and without dismissing the real need for some specific health and safety, risk assessment, and security programmes for activists), I believe the main attention for non-profit leaders should be around the fundamental assumptions they hold on how work is organised and how their organisation’s culture is expressed on a day-to-day basis. In other words, it means that they address issues of burn-out by truly working according to person-centric values.

Of course that is easier said than done. Indeed, addressing the problem related to the ‘badge of honour‘ culture, denotes something of the effort required to make such a shift. Indeed, potentially it would mean for non-profit leaders (and their donors), situated in a culture that expects high-engagement, to open up a work-life conversation that could fundamentally alter organisational expectations of employees. Brigid Schulte addresses this over-work phenomenon (You Can Be a Great Leader and Also Have a Life, 2018)^[xiii] by noting that leaders need to model in themselves the necessary change in organisational culture. How they need to learn to work differently, by making a priority of relationships outside work, and by shifting their own mindsets about work. Moss (2019) says that leaders: ‘…can mitigate this “always-on” mindset by being aware of when passion becomes a double-edged sword. … We need to teach people that setting boundaries is OK. It’s not selfish. It’s actually selfless. It allows you to be more effective at what you do, and to better [help] those you wish to serve.’

Seppälä and Moeller (2019), by focusing on the key differences they found between ‘optimally engaged’ and ‘engaged-exhausted’ employees, give some insight to this. ‘Half of the optimally engaged employees reported having high resources, such as supervisor support, rewards and recognition, and self-efficacy at work, but low demands such as low workload, low cumbersome bureaucracy, and low to moderate demands on concentration and attention. In contrast, such experiences of high resource and low demands were rare (4%) among the engaged-exhausted employees, the majority of whom (64%) reported experiencing high demands and high resources.’ Indeed, they go further and propose that: ‘…data suggests that while wellness initiatives can be helpful, a much bigger lever is the work itself. HR should work with front-line managers to monitor the level of demands they’re placing on people, as well as the balance between demands and resources. The higher the work demands, the higher employees’ need for support, acknowledgement, or opportunities for recovery.’

All this underlines the qualities required to attend to the complex and holistic issues around occupational burn-out. While wanting employees to be engaged and fulfilled, that must not be to the detriment of their health and, ultimately, to the work of the organisation. It requires appropriate resources for stretched work-roles, where managers and HR need to be able to help employees reduce the demands they put on themselves. The governance/leadership of an organisation has to take an overwork culture seriously, to ensure that employees’ goals are realistic and balanced, and that ‘…intangible resources such as empathy and friendship in the workplace, and letting employees disengage from work when they’re not working’ are truly valued. To me, in the end, it means that a whole organisational approach is required.

^[i] https://www.who.int/mental_health/evidence/burn-out/en/

^[ii] https://www.humanrightscareers.com/magazine/burnout-as-human-rights-worker/?fbclid=IwAR0r2zwVGVjx-h8boZU27fi5LryGI4Sg9GSu2NXWwjvccDZJsOk-UQaoHtQ

^[iii] https://www.gallup.com/workplace/237059/employee-burnout-part-main-causes.aspx

^[iv] https://hbr.org/2019/07/when-passion-leads-to-burnout?utm_campaign=hbr&utm_source=facebook&utm_medium=social&fbclid=IwAR0NpI1dncCUzc2fqdKFRh-zHNR5ci6A4TB1subYLO-zUF_uCidFJFrSYz8

^[v] Exemplified by much macho misappropriation of Neil Young’s song lyric: “It’s better to burn-out than to fade away” in My My, Hey Hey (Out of the Blue).

^[vi] https://www.gallup.com/workplace/237185/employee-burnout-part-organizations-stop-burnout.aspx

^[vii] https://www.gallup.com/workplace/237119/employee-burnout-part-2-managers.aspx

^[viii] https://hbr.org/2018/02/1-in-5-highly-engaged-employees-is-at-risk-of-burnout?fbclid=IwAR0Fspbgp3Seat3KiGtz5S_OyXGRhfDSSqz6N7OqYy_zQBVoDtYiF3FvvQo

^[ix] Leka, S., & Jain, A. (2017). EU Compass for Action on Mental Health and Well-Being: Mental Health in the Workplace in Europe – Consensus Paper. https://ec.europa.eu/health/sites/health/files/mental_health/docs/compass_2017workplace_en.pdf

^[x] Maslach Burnout Inventory™ Authors: Christina Maslach, Susan E. Jackson, Michael P. Leiter, Wilmar B. Schaufeli, & Richard L. Schwab. It is recognised as a leading measure of occupational burn-out. It measures burn-out as defined by the WHO and can be used as a toolkit to measure both the extent and likely causes of burn-out. Also see: Schaufeli, Wilmar & Leiter, Michael & Maslach, Christina & Jackson, Susan. (1996). Maslach Burnout Inventory — General Survey (GS). Maslach Burnout Inventory Manual. This third version of the MBI was developed across several occupations and countries, in order to assess burnout in all occupations. It is published and distributed online by Mind Garden www.mindgarden.com/products/mbi.htm

^[xi] https://www.who.int/mental_health/in_the_workplace/en/

^[xii] This somewhat parallels the classification of public health interventions into primary, secondary or tertiary prevention: ‘Primary interventions are proactive by nature; the aim is to prevent exposure to a known risk factor and in this way prevent harmful effects to emerge. They may also aim to enhance an individual’s tolerance or resilience. Secondary interventions aim to reverse, reduce or slow the progression of ill-health and preclinical conditions or to increase individual resources. These secondary approaches may include both early detection and early treatment with the aim of reducing the severity or duration of symptoms and to halt or slow the further development of more serious and potentially disabling conditions. Finally, tertiary interventions are rehabilitative by nature, aiming at reducing negative impacts and healing damages. They aim to treat and manage an existing diagnosed condition and minimize its impact on daily functioning through approaches such as rehabilitation, relapse prevention, by providing access to resources and support, and by promoting reintegration in the workforce’ (Leka & Jain, 2017).

^[xiii] https://hbr.org/2018/12/you-can-be-a-great-leader-and-also-have-a-life?utm_campaign=hbr&utm_medium=social&utm_source=facebook&fbclid=IwAR2jrehJUcq4WUMuCY580vW5MxrE7uP5PaZgI4WZMtfzulWYd8WtJtgcrqQ