It is those who work “on the front line” in public administration, such as doctors, nurses, and teachers, who concretely determine the effectiveness of public policies. That is why it is essential to understand the factors that affect the quality of their work. One of the central elements is the way these professionals perceive the organization in which they work. In particular, organizational justice and the meaning they attribute to their work prove to be essential resources for protecting their well-being and psychological resilience.
A study by Elisabetta Trinchero, Matthew Xerri, Yvonne Brunetto, and Alberto Firenze, published in the European Management Journal, shows that when professionals perceive fairness in decision-making processes, equity in treatment, and quality in everyday relationships, the risk of emotional exhaustion decreases; moreover, when work is perceived as meaningful, protection against burnout becomes even stronger.
A question of fairness?
The research fits into the strand of studies on street-level bureaucrats, that is, those public professionals who work in direct contact with citizens and who, in doing so, exercise an inevitable degree of discretion.
In recent years, this issue has become even more relevant for two reasons. On the one hand, public organizations, especially in OECD countries, have been subjected to growing pressure: greater demand for services, fewer resources, and greater accountability. On the other, reforms inspired by New Public Management have introduced logics of efficiency and control that can come into competition with professional values.
In this context, the daily work of street-level bureaucrats plays out in a delicate balance among system rules, resource constraints, and expectations.
The literature had already highlighted the importance of “discretion” and “public service motivation.” Less clear, however, was the link, on which the study focuses, among three factors:
- Perceptions of organizational fairness.
- The meaning of work.
- Psychological well-being.
Three determining factors
The study analyzes the perceptions of 705 public-sector healthcare professionals—doctors and nurses—in Sicily, Italy, during the COVID-19 pandemic in 2021, using a two-phase survey conducted eight weeks apart to reduce response bias.
The authors measure four main dimensions: organizational fairness, the meaning of work, emotional exhaustion, and overall well-being.
The results are particularly interesting because they quantify the phenomena:
- Perceptions of fairness explain only a limited part of the sense of meaning at work (8.1% of the variance), a sign that personal and professional factors also come into play.
- Taken together, fairness and the meaning of work explain about 20.4% of emotional exhaustion.
- Emotional exhaustion, fairness, and meaning explain as much as 67.9% of overall well-being—a very high figure for studies of this kind.
The importance of prevention
The most relevant conclusion for those who manage complex organizations is that well-being is not built only by “adding” positive factors such as motivation, meaning, and engagement, but also and above all by avoiding the depletion of psychological resources.
For healthcare managers, and for anyone managing street-level bureaucrats, the research suggests that:
- Organizational justice is not a “soft” issue: transparent processes, fair distribution of resources, and the quality of relationships directly reduce the risk of burnout.
- The meaning of work helps, but it is not enough: even highly motivated professionals, such as doctors and nurses, can break down if organizational conditions are deteriorating.
- Prevention is more effective than motivation: reducing unrealistic workloads, decision-making opacity, and role conflict has a greater impact than interventions aimed at individual engagement.
In light of the results, policymakers should reflect on the fact that reforms that increase pressure and control without strengthening resources risk wearing workers down and inevitably worsening the quality of services. And they should remember that burnout is not merely an individual problem, nor an inevitable consequence of care professions. It is also, and perhaps above all, an organizational outcome.
The research topics are also addressed in the program Risk management in sanità (in Italian).
Elisabetta Trinchero, Matthew Xerri, Yvonne Brunetto, Alberto Firenze. “Meaningful work and fair treatment: Vital elements for street-level Bureaucrats' defence against emotional exhaustion and poor well-being.” European Management Journal, DOI: https://doi.org/10.1016/j.emj.2025.12.001.
