Fatigue risk management in healthcare: A scoping literature review

Abstract

Background: Occupational fatigue among healthcare professionals is a complex, multifaceted issue associated with increased likelihood of medical error, compromised patient safety and negative impacts on staff mental and physical health. While safety-critical sectors such as aviation and rail have implemented formal systems to manage fatigue-related risks, it remains unclear whether similarly structured approaches exist or operate effectively within healthcare.

Objective: This scoping literature review aimed to examine the current state of knowledge regarding fatigue risk management strategies and countermeasures in healthcare and explore the barriers and facilitators to their implementation. This review sought to highlight gaps and provide insights into advancing fatigue risk management practices within the healthcare context.

Methods: A systematic literature search to June 2025 was conducted across Medline, CINAHL Ultimate, and Scopus databases. Search terms were developed based on key concepts related to healthcare professions and fatigue risk management. Studies were included if they examined fatigue risk management strategies, countermeasures or organisational perceptions of fatigue in healthcare.

Results: Thirty-two studies met the inclusion criteria, including quantitative (n = 18), qualitative (n = 9), and mixed-methods (n = 5) designs. Findings were grouped into conceptual categories based on the study focus and/or intervention type. The majority of studies (n = 18) evaluated isolated interventions including informal/individual fatigue management strategies, napping, use of biomathematical models to predict fatigue risk, fatigue education, and the impact of scheduling practices. Only two studies reported on comprehensive, multi-component programmes. Nine studies explored staff perceptions and attitudes toward fatigue-related strategies, and three examined broader organisational understanding or design principles related to fatigue management. Key barriers to implementation included normalised cultural attitudes towards fatigue, limited managerial support, and inadequate infrastructure. Facilitators included improved staffing levels, better workload distribution, supportive leadership, and the development of non-punitive safety cultures that encouraged fatigue reporting.

Conclusions: Despite growing awareness of the risks associated with occupational fatigue, healthcare systems continue to rely on fragmented, informal, and largely individual approaches to fatigue management. In contrast to other high-risk industries, healthcare has yet to embed fatigue management within formal safety governance structures. Advancing practice in this area requires a shift toward system-level thinking that is supported by organisational leadership, effective fatigue monitoring, and workforce education. Additionally, this shift also demands a cultural reorientation that recognises fatigue as a predictable and manageable safety risk that necessitates organisational accountability rather than individual resilience to prioritise both staff wellbeing and patient safety.

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Identifiers

ORCID for Stephanie Laura Jane Fox: orcid.org/0009-0004-2519-3782

ORCID for Mark Young: orcid.org/0009-0001-2594-453X

ORCID for Chiara Dall'ora: orcid.org/0000-0002-6858-3535

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