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Is it time for a Quadruple Aim?

 |  By Danielle Miller  
   November 08, 2016

IHI’s Triple Aim, focused on improving patient care quality and satisfaction, boosting population health and reducing costs, is central to all of our work. However, while the tenets of the aim are well defined, how we go about achieving the aim remains a lot less clear.

Lately, I have been pondering the barriers to truly achieving the Triple Aim. And I have noted one vitally important—but missing—ingredient in the quality, care and cost formula: the caregiver.

By caregiver, I mean anyone in the healthcare ecosystem: physicians, nurses, and every person who supports the patient, from physician assistants, to dietary aids to environmental services. You can’t provide quality care without a satisfied staff, and I think it is now time they be included in what should be a fourth tenet: ensuring staff satisfaction and engagement.  It’s time for the Quadruple Aim.

The high cost of burn out

Unfortunately, data and anecdotal evidence shows us that healthcare providers everywhere face burnout. That fizzling staff engagement goes hand-in-hand with lower patient satisfaction, reduced health outcomes, higher costs due to low productivity, and a very concerning risk for medical errors.

The statistics are disturbing: A 2012 paper published in the Archives of Internal Medicine found that an "alarming" 46 percent of 7,288 physicians surveyed reported at least one symptom of burnout. Burnout rates for nurses are startling as well, with 34% of hospital nurses reporting burnout symptoms, according to a 2011 report in the journal Health Affairs. When healthcare providers feel fried, consistently overworked and disengaged, the well being of the patient relationship and patient-centered approach are quickly at risk.

As healthcare professionals (and patients, ourselves) we know that happy and engaged providers offer better care and instill a sense of trust. For patients, that leads to better medical regiment compliance and overall satisfaction, and means less costly turnover for providers.

Achieving the Quadruple Aim

So how do we go about improving the work life of care providers, especially in light of changing payer models and increased regulation?

A leading point of caregiver dissatisfaction is the inability to access and exchange crucial patient information that impacts patient outcomes. That’s why it’s time to look at true interoperability. How can we give caregivers easy-to-use technology that gives them comprehensive, longitudinal pictures of patients’ clinical histories and treatments, regardless of where it was received in the hospital, post-acute system, or even the clinic setting? A fully integrated system enables better, faster decisions. It also aligns hospital policies to promote the use of HIT with processes and workflows, focusing on value rather than volume.

At the bedside, this reliable clinical decision support system encourages best practices and collaborative standardized care. Costs decrease when real-time data and access eliminates unnecessary duplicate testing and frustrating, time-consuming manual tasks.

A happy and engaged workforce provides enormous and essential benefits for both patients and healthcare providers. When organizations are able to fully leverage HIT systems, care providers can streamline, automate, and enhance their work. They are left free to spend more time doing what they entered the healthcare profession for—providing care for patients. When all these steps are in place, hospital organizations will transform their Triple Aim to the Quadruple Aim, a key in both provider—and patient—satisfaction.

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