Drivers of Burnout and Moral Injury

Burnout and moral injury are driven by a set of complex and intersecting factors. Overarching environmental factors contribute to relational and operational breakdown. Relational breakdown recognizes the distrust, values conflicts, lack of control, and inequities experienced in work and learning environments. Operational breakdown is seen in a lack of physical and mental health safety, excessive work demands, and inefficiencies. Often, operational breakdown has been the focus of interventions; however, burnout and moral injury will not be fully addressed without repairing distrust and other relational challenges.

Environmental Factors

Societal & Cultural
  • Politicization
  • Structural discrimination & racism
  • Policies & regulations
  • Market
  • Leadership
  • Organizational policies
  • Measurement & accountability
Work & Learning Environments
  • Culture & communication
  • Worker/learner supports
  • Workload & workflows

Relational Breakdown

  • Between the workforce and administration and patients/community and within teams
Values Conflict
  • Working/learning in suboptimal and/or unethical circumstances
Lack of Control
  • Lack of voice
  • Fear of retaliation
  • Unfair treatment & discrimination
  • Inadequate compensation & benefits

Operational Breakdown

Lack of Safety
  • Workplace violence & other occupational hazards
  • Inadequate, mismatched, and/or stigmatizing mental health supports
Excessive Demands
  • Physical, emotional, & cognitive overload
  • Insufficient staffing & resources
  • Administrative burden
  • Chaotic workflows / poor communication

Environmental Factors

While burnout and moral injury manifest in work and learning environments, they often originate in the larger societal and systems level factors that drive organizational priorities and behaviors.

Society and cultural factors can include politicization and structural discrimination and racism. Health and public safety systems, which include government and professional organizations, establish policies, programs, and regulations that influence organizations in direct and indirect ways. Additionally, the market economy in the U.S. impacts insurance reimbursement practices, the pricing of medications, staffing decisions, and other aspects of healthcare and public safety.

At the organizational level, leadership, organizational policies, and procedures can contribute to burnout and moral injury. Finally, the culture, supports, workload and workflows, and communication found within the work and learning environment, which includes hospital units, outpatient departments, local fire and police stations, classrooms, and other areas in which healthcare and public safety services are provided and learned, contribute directly to the experience of burnout and moral injury.


Addressing these environmental factors will require critical appraisal and change of existing policies, as well as new policies and investments to protect and improve the well-being of health and public safety workers and learners.  Explore strategies:


Relational Breakdown

Relational breakdown is core to the experience of burnout and especially moral injury. Distrust between the workforce and administration, within teams, and between workers and those they serve contributes to relational breakdown. Values conflicts – working or learning in suboptimal or unethical circumstances and having insufficient training and supports – are also a relational driver of burnout and moral injury. Furthermore, lack of control, which includes lack of voice and fear of retaliation, as well as inequities, manifested via unfair treatment and discrimination and inadequate compensation and benefits, can erode relationships within health and public safety.


Building trust requires strategies to engage and protect workers and learners, support and develop leadership, establish shared governance structures, align values, address inequities, and establish measurement and accountability for well-being. Explore strategies:


Operational Breakdown

A number of factors contribute to operational breakdown and, subsequently, burnout and moral injury. Lack of safety – workplace violence and other occupational hazards as well as stigma and inadequate supports for mental health and stress/trauma – can contribute to burnout and moral injury. Additionally, workers and learners often face excessive demands, including physical, emotional, and cognitive overload and insufficient staffing and resources; and operational inefficiencies from chaotic workflows and administrative requirements.


Resolving operational factors will involve utilizing the relational strategies above to engage workers in designing changes to workflows to reduce operational inefficiencies, creating safe staffing, ensuring fair and meaningful recognition and rewards, and providing appropriate resources for workers to effectively address their mental health and stress/trauma. Explore strategies:

Download the full framework

Download the PDF

Learn about the drivers, process, and outcomes of burnout and moral injury

Explore the Framework

Find actionable strategies to address burnout & moral injury

Find Actionable Strategies