Improved provider experience leads to increased patient care. If you can impact and improve the experience of the providers of care, you impact the care patients are receiving. Overworked staff can lead to burnout, so considering a fourth aim means looking at improving the experience of the provider. The ability of the hospital organization to obtain the Triple Aim is dependent on its ability to have an engaged workforce, including nurses, physicians, and anyone who provides support to the care of the patient - or pretty much everyone in the healthcare ecosystem. Expanding to the Quadruple Aim that includes the addition of improving the work life of health care providers, including clinicians and staff, may in essence help with achieving the Triple Aim. So what does that mean? Providers who are burned out may actually be an obstacle to organizations obtaining the Triple Aim. One can only assume the same is felt by all of healthcare staff who support the care of patients, including everyone from dietary to environmental services. Anecdotal evidence supports this is the case for physician assistants, as well as nurse practitioners. This rate is concerning for nurses as well with 34 percent of hospital nurses reporting burnout symptoms according to a 2011 report published by the Journal of Health Affairs. Unfortunately, healthcare providers everywhere face burnout which goes hand-in-hand with lower patient satisfaction and reduced health outcomes - it may even increase costs.Ī 2012 paper published by the Archives of Internal Medicine found an “alarming” 46 percent of the 7,288 physicians surveyed reported at least one symptom of burnout. And by providers, I mean physicians and nurses, but also everyone who supports the care of the patient. The Quadruple Aim incorporates the healthcare provider into the mix.

The Triple Aim has gained wide acceptance as a compass to optimize health system performance, but the question remains: how will organizations obtain the Triple Aim? Data suggests hospitals need to add another facet in order to be successful at obtaining the Triple Aim, so we are now looking at the Quadruple Aim. The framework’s intent seeks a simultaneous pursuit of improving the patient experience of care (including quality and satisfaction) improving the health of populations and reducing the per capita cost of health care. The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. By Danielle Miller, PHD(c), MSN, RNC-OB Chief Nursing Officer, Clinical Applications

Quadruple aim framework