Don Berwick and colleagues pioneered the Triple Aim paradigm in the health system, which emphasizes the pursuit of three dimensions of quality of care: improving population health, improving the patient experience, and reducing the per capita cost of care. The primary purpose of this approach is to improve the health of the target population, while the other two are secondary. The expansion of this paradigm to the Quadruple Aim is necessitated by the fact that a stressful work environment, combined with a stressful work environment, is undermining their capacity to meet the three dimensions of care metrics.
Presently, society keeps placing more demands on physicians and health systems at a time when a combination of the nursing shortage and increasing cost of care is reducing the available resources. From patients’ perspective, patient-centered care is conceptualized as an instant response to their care needs. This standard is difficult for caregivers to achieve in the present clinical environment. The severity of the challenges facing caregivers is evidenced by the fact that 46% have reported experiencing burnout (Bodenheimer & Sinsky, 2014). In particular, burnout is prevalent among physicians in the emergency department, neurologists, and family physicians. For instance, a 2014 survey revealed that 68% of family physicians and 73% of general internists would not choose the same career (Bodenheimer & Sinsky, 2014). This is a serious challenge because professional burnout translates into suicidal ideation, early retirement, and increased alcohol and substance abuse. The high levels of physician dissatisfaction must be interpreted as the rise of barriers to high-quality care in contemporary society.
Although the causes of burnout and stress are multifactorial, increased paperwork and administration activities are some of the leading causes. For example, a 2014 survey revealed that 43% of physicians are forced to spend about 30% of their day on administrative tasks (Bodenheimer & Sinsky, 2014). In addition, they are forced to spend a disproportionate amount of time away from face-to-face interactions with patients. The adoption of electronic health records, while integral in streamlining processes in a healthcare environment, has also contributed to physicians’ distractions. Emergency nurses have to spend 44% of their day doing data entry, so their day is spent on patients (Bodenheimer & Sinsky, 2014). Moreover, caregivers have observed that EHR has caused a tremendous increase in the time it takes to plan and review care plans.
Furthermore, burnout has been observed to affect other caregivers besides physicians. For instance, 34% of hospital and 37rsing home nurses have reported burnout (Bodenheimer & Sinsky, 2014). Those on the frontlines, such as receptionists, have not only decried long work hours, but also 68% of them have been victims of verbal abuse from their patients (Bodenheimer & Sinsky, 2014). They also feel they are trapped between the demands of their patients and those of their doctors. In a 2013 survey of 508 employees drawn from 243 healthcare employers, 60% of the healthcare providers reported experiencing burnout, while 34% voiced their desire to look for another job (Bodenheimer & Sinsky, 2014). Losing staff at a time when a rise in chronic illness and an aging population are increasing, the demands placed on the American health system could prove to be disastrous for population health outcomes. The fact that the cost of physician turnover is $250,000 highlights the significance of ensuring that appropriate efforts go into improving job satisfaction and commitment (Bodenheimer & Sinsky, 2014). The prevailing state of the health system leaves much to be desired and calls for urgent intervention measures to improve health outcomes.
Besides reducing empathy and causing compassion fatigue, burnout can cause a rise in medication administration errors. When nurses and medical assistants are worn out and dissatisfied, they will likely make human errors and fail to communicate or collaborate effectively with their colleagues. The fact that measures aimed at facilitating the attainment of Tripel Aim objectives are causing additional work and pressure for caregivers is unfortunate. It must be addressed to ensure quality care outcomes are maintained. In part, this is due to a need for more hiring of healthcare staff and the failure to design workflow in a way that the provision of care centers the interaction between the caregiver and the patient as opposed to compliance-related
In light of the sad state of affairs, it is evident that any progress that can be made about the Triple Aim requires a commitment to improving the well-being of care teams. Moving forward, stakeholders must appreciate that taking care of physicians and caregivers is the foundational step in creating an enabling environment for patients to be taken care of (Arnetz et al., 2020). Additionally, there is a need to ensure that more effort goes into meeting the needs and aspirations of the people.
Healthcare organizations can operationalize the Quadruple Aim by adopting deliberate strategies to create an enabling environment for physicians and other caregivers to have a positive work environment. Implementing team documentation can enhance information-sharing and collaboration among the medical team while allowing them to serve more patients and go home earlier. In addition, using pre-visit planning and pre-appointment laboratory testing can reduce the time used in reviewing lab results. Also, improving delegation would allow nurses and medical assistants to provide more help to physicians. Adopting standardized workflows can translate into five hours being saved each week and improving patient care quality. Similarly, co-locating teams can be integral in operational efficiency and save physicians about thirty minutes. Ensuring that practice staff members are well-trained and understand their roles will empower them to contribute meaningfully to providing care.
However, barriers to implementing the Quadruple Aim must be overcome to achieve positive treatment outcomes. Besides rising healthcare costs and income inequalities, the rise of chronic illnesses is increasing the demand for care (Hsieh, 2019). For example, obesity and diabetes epidemics are increasing in society, creating additional challenges to health systems. An increasing gap between the available resources to healthcare providers and what they get is creating an undue burden for the caregivers. Nonetheless, there must be a balanced approach to addressing the needs of both patients and caregivers to avoid replacing one challenge with another.
To conclude, stakeholders must advocate for increased commitment to the Quadruple Aim approach to care because it emphasizes the healthcare team’s well-being, which is instrumental in creating an enabling environment for patient-centered care. Although many physicians, nurses, and other caregivers conceptualize their career as a call to serve, stressors and barriers in the work environment can dampen their enthusiasm, causing compassion fatigue and job dissatisfaction. When they are cared for and fulfilled in their work, they are less likely to make errors and more committed to providing the best quality of care to all their patients.
References
Arnetz, B. B., Goetz, C. M., Arnetz, J. E., Sudan, S., vanSchagen, J., Piersma, K., & Reyelts, F. (2020). Enhancing healthcare efficiency to achieve the Quadruple Aim: An exploratory study. BMC Research Notes, 13(1), 362-368.
https://doi: 10.1186/s13104-020-05199-8
Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, 12(6), 573-577.
Hsieh, D. (2019). Achieving the Quadruple Aim: Treating Patients as People by Screening for and Addressing the Social Determinants of Health. Inventing Social Emergency Medicine, 74(55), 19–25. https://doi.org/10.1016/j.annemergmed.2019.08.436
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