The Work Ahead: Healing a System That’s Hurting Its Own
Not Burnout—Moral Injury
Lately, I’ve been thinking a lot about what’s happening across our hospitals and clinics—not just the policies, but the quiet, often invisible experiences of the people working inside them. The tension isn’t just about resources or protocols. It’s something deeper—how we stay true to why we got into this work in the first place, even as the system around us starts to feel more transactional than relational.
When I hear about sweeping policy changes—like the reversal at Allina Health, or nursing layoffs at urgent care centers—it’s hard not to see the bigger picture. These aren’t isolated decisions. They’re symptoms of something more fundamental. What we’re facing isn’t just burnout. It’s moral injury. That sense that we’re being asked to work in ways that go against what we believe is right.
It shows up in subtle ways: clinicians competing with one another for time, patients, or recognition because the system pits us against each other. As budgets shrink, so does trust. We lose sight of the fact that we’re on the same side. And that’s not a small thing—it erodes the very foundation of care.
I’ve seen this firsthand. As a surgeon, I’ve never done a procedure alone. Every case is a team effort. Nurses, anesthesiologists, techs—we all rely on each other. But when push comes to shove, the value of nursing is often reduced to a line item, not treated as essential to the healing process. And it’s demoralizing.
The truth is, we need a cultural shift. That doesn’t mean grand statements or slogans. It means starting from the simple idea that we assume good intent. That we have each other’s backs. That we mentor, check in, support, and—when needed—advocate. Because the care we provide isn’t just technical. It’s deeply human. And it needs to feel that way for everyone involved.
If we say that clinician well-being is part of our collective goals—as it is in the so-called “quadruple aim”—then we need to build systems that reflect that. I’ve always found it strange that patient satisfaction might influence a clinician’s compensation, but clinician satisfaction rarely factors into executive decision-making. Why not tie leadership compensation to how their teams are doing, emotionally and professionally? If we believe in accountability, it should flow in both directions.
Part of the problem is the disconnect between the clinical and administrative sides of healthcare. It’s easy for each to misunderstand the other. I’ve met plenty of administrators who care deeply about patients, but haven’t stepped into an emergency department on a night shift. And I’ve seen clinicians roll their eyes at administrators without any awareness of the regulatory and financial pressures they’re trying to navigate.
I don’t think the solution is complicated—it just takes time and willingness. Invite people to sit with each other. Shadow one another. Not as a symbolic gesture, but to actually understand what the other is up against. That kind of perspective changes things. It builds respect. And it helps us make better decisions.
Then there’s technology. We talk about it as the great hope—especially AI. And I do believe it can help. But too often, it’s implemented in ways that make things harder. It becomes one more dashboard, one more inbox, one more layer of noise. When that happens, it deepens the very wounds it was supposed to help heal.
I think we need to get back to basics. Work with people who understand the realities of clinical care. Build tools that fit into the way people actually work—not the way we imagine they should. And above all, remember that technology should extend our ability to care, not replace it.
The problems we face in healthcare are real. They’re heavy. But they’re not beyond our reach. I’ve seen what happens when people come together around a shared sense of purpose—clinicians, administrators, technologists. I’ve seen what’s possible when we let go of blame and start asking better questions. When we lead with empathy, and not just strategy.
This isn’t about a single fix. It’s about a way of working—a way of showing up for each other. The kind of culture that allows both care and innovation to thrive. Because if we want to rebuild trust, we have to start with relationships. And if we want our systems to heal others, we need to make sure they’re not harming the people inside them.
That, to me, is the work ahead.
Dr. Salim Afshar