**4. Pathophysiology**

The burnout and its contributing factors can be related to a microbiologic disease process in which burnout is the disease, environment works as a pathogen and an individual's resilience works as an immune system. As such, an individual working in a negative or negative environment (aggressive pathogen) is having hazards of burnout despite personal resilience, whereas an individual having poor resilience (immunosuppressed) may be having hazards for burnout even in a positive environment. This concept may help in understanding the reason for not developing burnout with same challenges. Considering this resemblance, environment could be considered as the pathogen for burnout. However, working as well as home environment is helpful in building our resilience, similar to the preparedness of immune system by vaccine against different diseases. A positive-working environment can have features like opportunities for personal growth, meaningful work, recognition from leaders, psychological safety, supportive colleagues, and adaptability. Personal physical, social, mental health, and positive interactions are other factors outside work environment that build resilience.

Thus, there are multiple factors taking part in the interactions contributing to developing burnout, it can be categories in two broad headings: institutional factors and individual (or personal) factors.

Institutional factors include the work environment, work culture, work schedule, growth opportunities, participation in decision making and peer support. Individual factors include self-care, work-life balance, and supportive relationships. Absence of these factors is predisposing factor for burnout.

### **5. Strategies to prevent and manage burnout**

Burnout among healthcare workers (HCWs) is a complex issue with no clear solution despite nearly a decade's efforts. This necessitates the expansion of the Triple Aim approach of improving health system performance (health of populations, the experience of health care, and reducing per capita costs of health care) to a Quadruple Aim by adding the aim of improving the work lives of HCWs and their experience of providing health care [26–28]. Given the history of well-being in medicine, the initial steps leaned heavily on the individual. As workplace culture and environment affect burnout, individual-focused interventions alone cannot sufficiently address the issue. Although well-intentioned, individual-focused interventions can hurt physician well-being efforts by promoting quick fixes rather than long-term solutions. Ignoring organizational contributors and potential interventions could percolate the message that individuals face burnout due to poor resilience and strength. Such messages can complicate the underlying problem by making individuals feel unsupported by their organization and losing trust in leadership. In medical school, we were taught that "where there is pus, must be evacuated" even though bandaging is easier and faster

*Occupational Stress among Health Care Workers DOI: http://dx.doi.org/10.5772/intechopen.107397*

than draining the pus, bandaging can make things worse. Likewise, we must fix the system to prevent future burnout and help those who are suffering currently.

Moreover, because of the various etiology of burnout, it is essential to understand each factor before selecting any specific intervention to avoid its futility. Organizational interventions alone will not be able to address burnout among a significant population of HCWs; an added personal intervention would enhance the effectiveness of organizational efforts. A growing body of evidence confirmed the efficacy of organizational interventions targeting the work environment and interventions targeting individuals in managing burnout [29–31].
