Moral injury in a VUCA healthcare environment: ethical complexities and professional challenges for medical teams

BACKGROUND: Healthcare systems operate within a VUCA (Volatile, Uncertain, Complex, and Ambiguous) environment, shaped by economic, demographic, and systemic transformations. These rapid and unpredictable changes create ethical challenges, resource constraints, and heightened emotional and moral distress for healthcare professionals. The increasing complexity of care delivery, shifting institutional priorities, and external pressures contribute to moral injury, impacting professionals' ability to provide patient-centered care while maintaining their ethical and professional integrity. METHODS: This qualitative study aimed to explore how healthcare professionals experience and cope with moral injury in a VUCA healthcare ecosystem. Through 35 semi-structured interviews, the study explores how healthcare professionals experience and cope with moral injury in such a dynamic healthcare ecosystem. The research uses an abductive analysis guided by the VUCA framework to examine the systemic roots of moral conflict. RESULTS: The analysis identified six themes highlighting how instability, unpredictability, ambiguity, and systemic overload shape clinical decision-making, emotional burden, and ethical distress. Participants described moral injury as emerging from the misalignment between professional values and institutional demands, intensified by resource shortages, role ambiguity, and crisis normalization. These pressures affect professionals' well-being, compromise ethical integrity, and contribute to long-term psychological consequences. CONCLUSION: The findings emphasize the need to move beyond individual-level resilience strategies and focus on systemic reforms. Strengthening institutional support structures-including ethical leadership, reflective spaces, and alignment between organizational policy and professional ethics-is essential for protecting both clinicians' integrity and care quality in today's complex healthcare landscape.