Cooperating for better care.

Christine Sinsky

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Time to push the ‘Quadruple Aim’


This column by Yul Ejnes, M.D., an internist and a past chairman of the board of regents of the American College of Physicians, says medicine needs a “Quadruple Aim” instead of the “Triple Aim”.

The “Triple Aim” is a concept developed in 2007 by Donald Berwick, M.D., and the Institute for Healthcare Improvement (IHI). Its three dimensions are “Improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.”

Then in 2014, to Doctors and Christine Sinsky published a paper in the Annals of Family Medicine titled “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider.”

Dr. Ejnes notes that “{T}hey very effectively made the case that our ability to achieve the triple aim is jeopardized by the burnout of physicians and other healthcare providers. They proposed adding a fourth dimension to the three in the triple aim: ‘the goal of improving the work life of healthcare providers, including clinicians and staff.”‘
“{E}fforts to achieve the triple aim have in many cases made things worse for providers. The added workload related to performance measurement, EHR use, greater documentation requirements, and increased access (expanded hours, e-mail, etc.) have had detrimental effects on the satisfaction and morale of members of the healthcare team.”

“It’s not about just physicians, either. All members of the healthcare team are at risk. The ‘Quadruple Aim’ bolsters the well-being of nurses, medical assistants, receptionists, and anyone else involved in providing care to patients.”

So here is Dr. Ejnes’s campaign platform:
“Healthcare leaders should discuss the quadruple aim when they would normally mention the triple aim, and explain to their audiences why that change is so important. (Also, when you hear a speaker refer to the triple aim, ask him/her about the quadruple aim in the Q&A.)
Changes designed to improve how we deliver care should also improve the work life of healthcare providers (and certainly not worsen it).”



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