Burnout as a System-Level Determinant of Patient Safety: Rethinking Risk in Healthcare Systems

Background: Despite substantial advances in recent decades, preventable adverse events remain a major challenge in healthcare systems. Increasing evidence suggests that burnout is a critical, yet underrecognized, determinant of patient safety. Objective: To critically analyze the relationship between burnout and patient safety and to propose a reinterpretation of healthcare risk grounded in human factors and complex systems theory. Methods: A structured narrative review informed by a systematic literature search was conducted using PubMed/MEDLINE, Embase, and Scopus, covering the period from 2000 to 2026. Studies evaluating the association between burnout and patient safety outcomes were included, with emphasis on systematic reviews, meta-analyses, and observational studies. Data were synthesized using a thematic approach. Results: Burnout is highly prevalent among healthcare professionals and is consistently associated with increased medical errors, adverse events, communication failures, and reduced quality of care. Organizational factors, rather than individual characteristics, are the primary drivers. These effects are mediated by cognitive and physiological impairments that compromise clinical performance and increase vulnerability to failures in care processes. Conclusion: Burnout should be recognized as a modifiable, system-level determinant of healthcare risk. Addressing it requires structural interventions targeting work organization, leadership, and care environments. Integrating professional well-being into patient safety strategies is essential to improve quality of care, strengthen system resilience, and reduce preventable harm.