Beyond resilience: How a systems approach is redefining burnout

The systems model

The US National Academy of Medicine's systems model helps us understand how this happens. Rather than viewing burnout through the narrow lens of individual endurance, the model maps how pressures interact across three interdependent levels:

Each layer shapes the next. Policy influences culture. Culture shapes practice. Frontline strain reverberates back through the organisation, eroding trust and driving attrition. Without intervention, this feedback loop becomes self-reinforcing—and self-destructive.

At the model's core sits a deceptively simple equation: burnout arises when job demands consistently outweigh job resources—what the model calls work system factors.

When demands continually exceed resources—when work consistently takes more than the system restores—exhaustion replaces energy and purpose gives way to detachment.

Because these forces operate simultaneously across all three levels, their effects intensify. Even the most resilient clinicians cannot indefinitely offset a structurally imbalanced environment.

The model recognises that individual mediating factors such as personality traits, coping strategies, and support networks influence how people experience workplace pressures. But these personal resources cannot compensate for systemic dysfunction. This is why wellbeing initiatives alone cannot solve burnout. Mindfulness sessions and resilience workshops may mediate symptoms, but without structural reform they risk suggesting that clinicians—rather than conditions—need fixing.

The external environment: When protection becomes burden

Let's examine each level of the model in turn, starting with the external environment where well-intentioned policies often arrive wrapped in administrative weight. Our ED nurse experiences this daily: accessing and recording information across multiple systems, completing mandatory training modules during shifts, following protocols that require additional handoffs and approvals. The impact is substantial—nurses lose more than a quarter of their time to documentation instead of direct care. Their medical colleagues face similar burdens, with NHS doctors spending nearly half their working hours on paperwork. When administrative requirements consume this much clinical capacity, protection has become burden.

Regulation matters. Documentation matters. But we need to ask whether our current approach is accidentally undermining the outcomes it seeks to protect.

A systems approach offers a different path. Shifting regulation from rigid compliance models toward shared governance can protect care quality while preserving the capacity to deliver it. Shared governance fosters ownership, accountability, autonomy, and teamwork—enabling clinicians to help shape supportive care environments rather than merely respond to external demands.

The healthcare organisation: The culture conduit

How organisations respond to external pressures makes all the difference. When leadership values align with clinical purpose, engagement deepens. When they diverge, value dissonance takes hold, quietly eroding purpose and accelerating burnout.

The biggest organisational pressure point is chronic understaffing. The NHS currently faces more than 102,000 vacancies, with nearly a third of staff considering leaving. This creates a vicious cycle of missed care, moral injury, and exhaustion.

Regularly running two nurses down means our nurse isn't just managing their own patient load—they're covering gaps, responding to requests that should go to absent colleagues, and making difficult choices about which tasks to defer. The emotional weight of these trade-offs accumulates: deciding whether to answer a relative's question now or respond to a clinical need first, knowing that whatever they choose, something important waits.

Professionals enter healthcare to help, not to apologise for what cannot be done. Striving to deliver excellent care while structurally constrained reduces motivation and leaves staff depleted. This isn't burnout from working hard; it's the exhaustion that comes from being prevented from working well.

Leaders can recalibrate this balance by investing in psychological safety, fair workload management, and recognition. These aren't "soft" interventions—they're the infrastructure of sustainable care.

The frontline: Where every system tension lands

This is where policy and organisational decisions converge into daily reality. For our nurse, the friction is constant. Digital tools that should streamline work instead multiply it, requiring the same information to be entered in multiple places. Phone calls pile up because there's no shared visibility of who needs what, when. Our nurse can't see the full picture of what's urgent, what's waiting, or where to focus next. Tasks remain invisible until someone physically tracks down the right person. Equipment that should be locatable isn't. Every inefficient process, every poorly integrated system, every communication breakdown compounds the next.

This isn't a deficit of endurance—it's a surplus of friction.

Transforming the frontline means simplifying workflows and aligning technology with clinical logic. When tools serve care rather than obstruct it, both efficiency and professional fulfilment rise. This is design work, not motivation work.

Redesigning the system: From insight to action

Sustainable change begins with recognising that wellbeing isn't a luxury—it's a precondition of effective care. When people are exhausted, even the best frameworks falter. When systems restore capacity and control, purpose returns.

A systems approach reframes leadership around three interlinked priorities:

Toward a system that heals

True transformation means treating burnout as what it is: a design problem demanding design solutions.

Healthcare systems internationally that have applied these principles demonstrate that systems redesign produces measurable improvements in both staff wellbeing and patient outcomes. Those that confront burnout at its roots do more than retain staff. They rekindle purpose and restore the conditions for safe, compassionate care. This happens when systems honour the natural rhythm of human work—clarity, flow, and recovery—allowing both wellbeing and performance to rise together.

The question facing healthcare leadership isn't whether burnout is a problem—the evidence is overwhelming. The question is whether we're willing to redesign the systems that create it.

That means asking uncomfortable questions: Which policies add bureaucratic weight without improving care? Where do our digital systems create work instead of reducing it? When did we last redesign workflows based on how clinicians actually work, rather than how we think they should?

We cannot add staff overnight. We cannot redesign national policy by next week. But we can examine every process, every tool, every meeting, every communication pattern and ask: Does this make it easier or harder for our people to do what they came here to do?

The systems model gives us the diagnostic framework. What's needed now is resolve: to move beyond treating symptoms toward repairing structural causes, to shift from expecting clinicians to be infinitely resilient toward building systems that are inherently sustainable.

The system won't heal itself. But it can be redesigned by people who recognise that burnout isn't inevitable—it's engineered. And what has been engineered can be re-engineered.