There is quite the buzz about the Quadruple Aim. Most of you are familiar with the Institute for Healthcare Improvement’s Triple Aim: enhancing patient experience, improving population health, and reducing costs. The Triple Aim is widely accepted as the end point of health reform. The Quadruple Aim takes this one step further. Simply put: the care of the patient requires care of the provider.
The authors of the Annuals of Family Medicine article make a strong case for a fourth dimension, the health care of the provider, as essential to achieve the Triple Aim. Although taken from a physician perspective, the implications of the Quadruple Aim are HUGE when we consider the totality of all those who work in the health care sector (physicians, nurse prescribers, physician assistants, nurses, psychologists, social workers, OT/PT, case/care managers, peers, just to name a few).
I would also argue that the mental health and wellness of our workforce should not be overlooked in the quest for the Quadruple Aim.
Why is this fourth dimension important? The issue of burnout impacts the quality and continuity of health care. We know that expectations for providers have heightened, resulting in organizational reconfigurations and changes in service delivery practices. The move to more robust, coordinated care and network development/sufficiency, the need to demonstrate outcomes (while meeting the contracted number of encounters), and a push for innovations without the necessary financing to fully implement integrated health care, all add to the strain and potentially impacts our workforce.
How can health care organizations work toward the fourth aim? The authors offer some practical steps, such as use of EMRs; expanding the role and scope of practice for nurses and medical assistants; standardizing and synchronizing workflows; providing team based care including co-location of team members; training; and assessing current workflows and practices and “reengineering” unnecessary work out of the practice. The adage, “because we have always done it this way” will no longer be acceptable if providers are attempting to actualize the Quadruple Aim.
The authors remind us that patient-centeredness is essential to the health care relationship. Health care is a relationship between those who provide health care and those who receive health care. It is a relationship that can only prosper if it is truly collaborative, respectful and seeking the same health care goals and outcomes. Patient-centeredness must be at the core for the health care relationship to thrive.
The authors conclude that the Triple Aim has provided us a vision of what a reformed health care system can look like. They present a compelling case that the health care workforce is of paramount importance in achieving one of the primary goals of the Triple Aim: improving population health. Heathy people, healthy communities, and a healthy nation. Collective impact. Only a truly healthy health care workforce can achieve the Triple Aim of improved care, better health, and lower costs – the true aim of health care reform!