Let's Make 2016 the Year of the Quadruple Aim

Thursday, December 24, 2015 | Larry Sobal

In October 2007 the Institute for Healthcare Improvement (IHI) launched the Triple Aim initiative designed to help health care organizations improve the experience of care (including quality, access, and reliability) while lowering—or at least reducing the rate of increase in—the per capita cost of care. The premise was that pursuing these three objectives at once allows health care organizations to identify and fix problems such as poor coordination of care and overuse of medical services. It was also intended to help them focus attention on and redirect resources to activities that have the greatest impact on health.

The Triple Aim has become an iconic moniker for where health care strives to be and it’s hard to argue against its merits. However, it’s time to face reality and modernize the concept; the Triple Aim is lacking a 4th fundamental element, one that arguably must be accomplished before the other three will occur.

I’m talking about replacing the Triple Aim with the more appropriate and realistic Quadruple Aim, for without improving clinician and caregiver experience, the original three goals of the triple aim simply won’t happen.

If you spend any time within health care facilities and talking to physicians and other caregivers, you’ll hear the stories of how we have taken an already challenging and complicated industry, and put our most valuable resources in sometimes impossible situations. What I’m speaking of are the alarming levels of stress and burnout among physicians and other health professionals. 

Why don’t we make 2016 the year to loudly call attention to epidemic levels of stress and burnout, and make the fourth aim our number-one priority so that the other three aims have a chance.

As just one example, Mayo Clinic recently published a study comparing burnout and satisfaction with work-life balance in physicians and the general U.S. working population between 2011 and 2014. We should all be distressed that 54% of the physicians who participated in the survey reported at least one symptom of burnout in 2014, an increase from 45.5% in 2011. Furthermore, satisfaction with work-life balance declined from 48.5% to 40.9% during the same period. In contrast, minimal changes in burnout or satisfaction with work-life balance were observed between 2011 and 2014 in probability-based samples of working U.S. adults not in the health industry. This is just one of many studies showing similar data.

But it’s not just physicians I’m worried about. The data related to nursing and other health care professionals also show high levels of burnout and depression. Similar to physicians, reasons often cited include increasing administrative (nonclinical) tasks, heavy patient loads, smaller staffs and higher stress levels.

So tell me, is the Triple Aim realistically achievable without engaged and satisfied clinicians?  I don’t think so. While there are some progressive organizations already replacing the Triple Aim with Quadruple Aim, I don’t see it happening as quickly or as broadly as it should. Why don’t we make 2016 the year to loudly call attention to epidemic levels of stress and burnout, and make the fourth aim our number-one priority so that the other three aims have a chance.

We should all be distressed that 54% of the physicians who participated in the survey reported at least one symptom of burnout in 2014, and increase from 45.5% in 2011. Furthermore, satisfaction with work-life balance declined from 48.5% to 40.9% during the same period.

On a final note, in case you are not already a fan of ZDoggMD, the link below is one of his great music videos about what life would be like without RNs. Enjoy and have a happy holiday season!

I Try (To Be A Nurse) | Macy Gray Parody | ZDoggMD.com

 

---

Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

---