Our original paper in STAT News was borne of close observation, scores of informal conversations, and thoughtful background research, but it was a thought experiment - a carefully considered hypothesis to gauge others’ similarity of experience.
The response to that article was overwhelming and consistent but it was gut-level validation. Scientists, like healthcare professionals, want empirical data to back up even their strongest visceral responses.
We are gathering that data, in various categories and with various collaborators, in the U.S. and abroad.
Why Moral Injury Matters
Reframing distress to include moral injury resonates with health workers’ experience and reframes the approach to solutions.
Talbot SG, Dean W. Physicians aren't 'burning out.' they're suffering from moral injury. STAT. Published July 26, 2018.
Dean WK, Talbot SG. Autonomy, mastery, respect, and fulfillment are key to avoiding moral injury in physicians.The BMJ Opinion. Published January 24, 2020.
Dean W., et al. Moral Injury and the Global Health Workforce Crisis — Insights from an International Partnership.New England Journal of Medicine. 2024;391:782-785. DOI: 10.1056/NEJMp2402833
Who Experiences Moray Injury and How
Mitigation starts with knowing who is at risk of moral injury, what factors contribute to the experience, and how it’s related to other challenges.
Beck J, Falco CN, O'Hara KL, Bassett HK, Randall CL, Cruz S, Hanson JL, Dean W, Senturia K. The Norms and Corporatization of Medicine Influence Physician Moral Distress in the United States. Teach Learn Med. 2023 Jun-Jul;35(3):335-345. doi: 10.1080/10401334.2022.2056740. Epub 2022 Apr 25.
Lennon RP, Parascando J, Talbot SG, Zhou S, Wasserman E, Mantri S, Day PG, Liu R, Lagerman M, Appiah A, Rabago D, Dean W. Prevalence of Moral Injury, Burnout, Anxiety, and Depression in Healthcare Workers 2 Years in to the COVID-19 Pandemic. J Nerv Ment Dis. 2023 Dec 1;211(12):981-984. doi: 10.1097/NMD.0000000000001705.
Dean W, Morris D, Mazur M, Talbot S. Moral Injury in Health Care: A Unified Definition and its Relationship to Burnout. Fed Pract. 2024 April;41(4):104 | doi:10.12788/fp.0467
Pittman P, Chen C, Munoz L, Dean W, Perlo J, Blanchard J, Ziemann M, Dent R, Talbot S, Strasser J, Nedrow K. Understanding and Addressing Health Worker Burnout and Moral Injury. Health Affairs Forefront. May 19, 2025.
Morris, D.J., Webb, E.L., Kamath, S., Worsfold, J.J. and Dean, W. (2025), "Looking beyond the frontline: senior healthcare leaders’ personal, professional and psychological experiences of the COVID-19 pandemic in the UK", International Journal of Workplace Health Management, Vol. 18 No. 2, pp. 219-237. https://doi.org/10.1108/IJWHM-12-2023-0188
What To Do
The most exciting work is building evidence for morally centered care that benefits administrators, clinicians, and patients.
Dean W., et al. Moral Injury and the Global Health Workforce Crisis — Insights from an International Partnership. New England Journal of Medicine. 2024;391:782-785. DOI: 10.1056/NEJMp2402833
Morris D, Dean W, Webb E, Wainwright J, Hampden R, Talbot S. Guidance for creating morally healthy organizations that remediate the experience of moral injury in healthcare: Findings from an international e-Delphi study. J Occup Environ Med. 2024 Dec 12. doi: 10.1097/JOM.0000000000003285. Epub ahead of print. PMID: 39663983.
Our Partners In This Work
National Framework for Addressing Burnout and Moral Injury
Our team was selected by the Health Resources and Services Administration in 2022 to provide technical assistance to 44 recipients of a total of $100M in funding it address clinician distress. As part of HRSA’s funding to our coalition (the “Workplace Change Collaborative”, we also were tasked to develop a national framework on burnout and moral injury.
Our partners in this work
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