Abstract for: The complex problem of burnout complaints among Dutch healthcare workers - a System Dynamics study

Burnout complaints are consistently higher among healthcare workers (HCWs) than in the general workforce and have important consequences for quality of care, staff turnover, and absenteeism. Despite sustained policy attention, the problem persists. Understanding the underlying system dynamics that generate these trends is necessary to identify effective policy interventions. Healthcare workers and academic experts developed causal loop diagrams through group model building and interviews to capture the dynamics underlying burnout complaints. Key feedback loops were extracted and integrated into a parsimonious causal structure, which was translated into a system dynamics simulation model. The model was iteratively developed, tested, and analyzed through sensitivity and scenario analyses. The model reproduced the long-term decelerated growth trend in burnout complaints among healthcare workers (R² = 0.90), although oscillations were not fully captured. Theil’s inequality decomposition indicates that most of the error is unsystematic (Uc = 0.88). Sensitivity analyses identified several parameters that informed policy experiments. Combined policies — improving quality-of-care programs, reducing fear of making mistakes, and strengthening supervisor support — reduced burnout prevalence and absenteeism while improving quality of care across future scenarios. Combining these policies was necessary, as isolated policies had either minimal effects or improved some indicators while worsening others. Ongoing work focuses on refining the dynamic hypothesis and incorporating policy processes to better explain observed oscillations and strengthen the model’s structural and behavioral validity.