Burnout and brownout are commonly framed as individual wellbeing states. This paper re-
frames both as manifestations of organisational cognitive load misalignment expressed
through clinical decision behaviour. The Organisational Cognitive Load Diagnostic Engine
(OCaLDE) estimates cognitive load using behavioural decision telemetry and workflow pat-
terns, and aggregates results to produce structural diagnostics for governance and operational
redesign. The objective is organisational diagnosis, not individual surveillance.
Clinicians operate within finite cognitive bandwidth. Two symmetrical failure states arise when
cognitive load is misaligned with capacity:
Burnout (overload): sustained cognitive overload characterised by multitasking, interrup-
tion density, role stacking, and decision fatigue. Observable consequences include reduced
diagnostic calibration, increased heuristic reliance, shortened consultation depth, and shift-end
performance drift.
Brownout (underload): sustained cognitive underload characterised by low challenge work,
extended idle time, disengagement, and vigilance decline. Observable consequences include
reduced vigilance, slower processing, skill atrophy, and diminished professional agency.
Both states increase risk, albeit via opposite trajectories.
Most current measurement approaches rely on surveys, wellbeing programmes, and productivity
proxies. These methods are (i) delayed, (ii) subject to reporting bias, and (iii) weakly connected
to decision behaviour. OCaLDE targets this gap.