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A healthy, safe and engaged healthcare workforce is fundamental to a high performing and sustainable health system that delivers high quality patient care.
Yet Australian doctors and medical students continue to experience escalating work pressures, including long hours, excessive workloads and the cumulative impact of the emotional demands of clinical practice. Despite increased attention to these issues, rates of burnout, psychological distress and suicidal ideation among medical professionals remain unacceptably high.
Historically, many responses to workforce burnout risk in healthcare have centred on individual level interventions such as resilience training and standalone wellbeing programs. While these approaches may offer short-term benefit, evidence consistently demonstrates they are insufficient when implemented in isolation. Poor workforce wellbeing is not primarily the result of individual vulnerability, but a predictable consequence of how work is designed, governed and led. Sustainable improvement therefore requires action on system level and organisational factors that shape everyday clinical work.
Turning frameworks into action
In 2021, South Australia amended its’ Health Care Act to strengthen workforce culture and staff wellbeing responsibilities of governing boards and health services. This change provided a clear mandate for greater accountability by senior leadership.
Recognising the urgent need for a new approach to drive change, the Commission on Excellence and Innovation in Health (CEIH) commenced work in 2022 to develop and operationalise a coordinated, system‑wide approach to workplace wellbeing across South Australia’s public health sector. This initiative aligns closely with the intent of the Every Doctor, Every Setting (EDES) framework, which emphasises healthy and safe working environments as central to workforce wellbeing and quality patient care.
Following consultation and review of national and international evidence, the CEIH released a discussion paper and framework in early 2023. The framework provides an evidence informed roadmap for foundational and sustainable change — not a standalone wellbeing strategy. The focus was on identifying and prioritising action on upstream and systemic drivers of job stress, burnout risk and turnover, consistent with the primary prevention emphasis of EDES, particularly Pillars 1, 4 and 5.
This work led to establishment of a formal governance structure under the SA Health Chief Executives’ Council. A dedicated committee and action plan supports coordinated action across the SA health system. Priorities include visible leadership commitment, clear accountability and measurement, leadership and management capability, and design of healthy and safe systems of work.
Recognising system level reform must be complemented by action at the service level, the CEIH has partnered with individual Local Health Networks to support implementation within organisations and clinical divisions. Using the CEIH framework, these partnerships have focused on addressing work design factors through staff codesign, strengthening wellbeing measurement systems, embedding workplace wellbeing into routine operating systems, and ensuring it informs clinical governance and decision-making.
So what’s changed?
Leadership and governance play a central role
Consistent with EDES, South Australia has established a clear governance structure for workplace wellbeing. Starting with the South Australian Health Care Act reforms in 2021, and the Work Health and Safety (Psychosocial Risks) Amendment Regulations (SA) in 2023, Local Health Network governing boards have clear statutory responsibilities for the health, safety and wellbeing of their workforce. This has resulted in the majority of LHN’s establishing dedicated wellbeing roles, including Director of Staff Wellbeing positions, incentivised by key performance indicators relating to dedicated resourcing for this work. At a system level, a committee was established and has been in operation for over three years, led by senior executives across people and culture, clinical leadership, public health, Aboriginal health and healthcare administration. This structure provides strategic oversight of systemic drivers of workforce wellbeing and enables escalation where local risks cannot be resolved.
Mobilisation of existing capacity
Protecting and promoting doctors’ wellbeing is a shared responsibility across the health system. In a constrained fiscal environment, meaningful progress requires better mobilisation of existing capability. CEIH’s work has focused on breaking down silos and aligning efforts across people and culture, clinical governance, safety and quality, digital health and operational leadership towards the common goal of identifying and working on key priority areas.
Measurement enabling accountability and action
In 2022, inconsistent approaches to measuring workforce and workplace wellbeing limited the ability to track progress across SA Health. In response, renewed systems for consistent and contemporary measurement, monitoring and reporting have been embedded. This includes introduction of key performance indicators relating to wellbeing and culture, such as leadership capability, hazard reporting and psychological safety initiatives. The consistent use of lead and lag indicators will support targeted and coordinated action across the system, as well as enabling accountability in line with the Health Care Act legislative requirements.
Sustainable healthcare requires deliberate work redesign
CEIH’s framework adopts a dual approach to workplace wellbeing, addressing work-related stressors and inefficiencies from both top down and ground-up perspectives. At system and health service levels, initiatives aligned with EDES Pillar 1 are underway to address known drivers of burnout risks, including improvements to medical rostering, strengthened fatigue management policies and practices, and focused efforts to prevent and manage occupational violence.
In parallel, the CEIH is working with the Women’s and Children’s Health Network to implement the framework within two clinical divisions as part of a research project using co‑design methodology.
Looking ahead
The aspiration for South Australia is a health system supported by a thriving and sustainable workforce, equipped with the professional and organisational resources required to meet increasing community demand. Spurred on by regulatory and policy change, real-world impact has been seen through focused efforts on establishing the foundations for this future through strengthened governance, leadership capability and accountability for workplace wellbeing. We appreciate we still have a long way to go.
The longer-term objective is to move beyond managing the inherent risks of healthcare work, towards systems deliberately designed to optimise both patient outcomes and workforce wellbeing. By further embedding accountability, mobilising existing resources, supporting leaders, codesigning work with frontline clinicians and applying a wellbeing lens to clinical governance and decision-making, South Australia is working towards eliminating the need for standalone wellbeing strategies. Instead, workforce wellbeing becomes an outcome of a health system designed to perform effectively for patients, clinicians and the wider community.
For more information on South Australia’s approach, visit:
https://ceih.sa.gov.au/our-work/strengthening-workplace-wellbeing
Isla Woidt BHumMov, BBus, MPH is the Strategic Lead, Workplace Wellbeing Partnerships at the Commission on Excellence and Innovation in Health (CEIH), South Australia. She has more than 20 years’ experience in workplace health and wellbeing across multiple industries, particularly the healthcare sector. Her work focuses on system‑level approaches to improving working environments and organisational culture.
Katie Billing RN, BNurs, GradCertEmergNurs, EMPA is an executive leader in the public sector in SA with and a registered nurse with background in general and emergency nursing. She holds an Executive Master of Public Administration from the Australian and New Zealand School of Government (ANZSOG) and Monash University. Her work focuses on partnerships, collaboration, and relationship‑based approaches across the public sector and community.
The Every Doctor, Every Setting (EDES) Framework and Action Plan are Australia’s national approach to strengthening the health, wellbeing, and psychosocial safety of doctors and medical students across all career stages and work settings.
Led by the National Doctors Health and Wellbeing Leadership Alliance (NLA), EDES provides both a shared framework and a practical action plan to drive change at individual, organisational, and system levels. Since 2023, EDES has been supporting the medical sector to move from commitment to implementation though leadership, practical tools and real work examples.
The EDES Insight+ Series highlights initiatives that align with the EDES showcasing how organisations and individuals are translating EDES priorities into meaningful, on the ground action across diverse medical settings.
To learn more about the EDES Framework and Action Plan, or to explore how your work aligns with EDES, visit www.everydoctoreverysetting.org.au.
This program is funded by the Australian Government Department of Health, Disability and Ageing.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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