Creating the Conditions for Flourishing: An Integrated Framework for Healthcare and Health Professions Education.

Healthcare and health professions education (HPE) organizations operate within complex ecosystems shaped by economic, workforce, regulatory, technological, political, educational, and societal pressures. These forces influence institutional priorities and the conditions in which people work and learn. Burnout and moral distress among clinicians, educators, staff, and learners can be understood in part as manifestations of misalignment between system demands and human needs and values. Although attention to burnout has been essential, approaches centered primarily on mitigating distress or strengthening individual resilience offer an incomplete aspiration for healthcare and HPE. Scholarship on flourishing points toward a higher-order aim: enabling people and communities not merely to avoid harm, but to experience meaning, connection, engagement, growth, contribution, and worthwhile purpose. Yet existing scholarship on flourishing, motivation, interdependence, organizational design, and organizational learning has largely illuminated separate parts of this challenge rather than providing an integrated account of how organizations can create the sustainable conditions for workforce and learner flourishing. We propose an integrated, multilevel framework for workforce and learner flourishing comprising four interconnected and mutually reinforcing foundations: (1) centering workforce well-being in service of flourishing; (2) fostering a culture of interdependence; (3) designing organizational and educational environments that support autonomy, competence, and relatedness; and (4) measuring and sustaining flourishing through organizational learning and accountability. These foundations operate within a broader healthcare and educational ecosystem that both constrains and enables institutional action. Our contribution is to integrate these previously distinct perspectives into a systems-oriented framework that shifts attention from helping individuals withstand demanding environments toward understanding how organizations can create, sustain, and advocate for conditions in which people and communities can flourish. The framework intentionally encompasses physicians, advanced practice professionals, nurses, allied health professionals, staff, educators, and learners. We position HPE as a formative subsystem within the broader healthcare ecosystem: one that can perpetuate existing norms and structures or serve as a critical lever for transforming them in support of a thriving and sustainable workforce.