The Quadruple Aim: A Square Deal for Clinicians (& Patients)

I've had the opportunity to visit hundreds of clinics and hospitals which has afforded me the chance to speak with clinicians of all types (doctors, nurses, techs, etc.). Most of my recent visits have been to the highest performing organizations where the physician satisfaction was a stark contrast to the 2012 study that found that 9 out of 10 physicians across the country are unwilling to recommend the profession to others. My unscientific observation was that the organizations that were performing the best on clinical measures consistently had the most professionally satisfied clinicians. Unsurprisingly, the revolution to reinvent healthcare is being led by doctors.

These are the organizations that realized how horrible the status quo is for clinicians and patients alike. This is why they have contributed to the various elements of the Health Rosetta best practices (how to purchase healthcare services wisely) and Health Rosetta Principles (guiding principles for how health-related organizations succeed in the new health ecosystem) that lay out the blueprint for where healthcare should be headed.

From a practical perspective, I don't believe many of the changes foisted on clinicians today are sustainable. Layering more stuff on top of a clearly-broken process isn't the path to success. This approach breaks the first rule I learned as a new consultant fresh out of college: Always fix a process before adding technology. Sadly, healthcare is riddled with technology being dumped on top of broken processes.

The question for me became whether there was data to back up my observations. It turns out there is some data (H/T Dr. Annie Valente for sharing that report). The Lancet reported on this recently.

When physicians are unwell, the performance of health-care systems can be sub-optimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

In parallel, I began hearing Dr. Rushika Fernandopulle talking about the Quadruple Aim. Given Iora Health's success (read more here) and the opportunity to learn from Tony Hsieh's organization, it made logical sense. Naturally, a professionally satisfied and challenged clinician is going to perform better. This has led to call by The Annals of Family Medicine to extend the Triple Aim to the Quadruple Aim. They summarized the article as follows:

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

It's common sense that an improved care team experience (note that the care team includes both professional and non-professional members of the care team such as family caregivers) naturally leads to an improved patient experience. That's when the "magic" happens of a partnership between the care team and the patient that naturally leads to improved health outcomes. In the proper model, that leads to reduced costs.

As Teddy Roosevelt would have said, extending the "aims" to the fourth aim is the Square Deal that benefits all parties.

Related article: The Doctor Dropout Drug

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Dave Chase is the co-founder of the Health Rosetta (a LEED-like organization for healthcare), and author of the book, “The Opioid Crisis Wake-up Call: Health Care is Stealing the American Dream. Here's How We Take it Back.” Follow the link to the book for a free download of the book. Chase's TEDx talk was entitled "Healthcare stole the American Dream -- here's how we take it back." See the Health Rosetta website for how to get involved, resources and how to join others to support its mission.

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