Administrators who are afraid to speak up about problems for fear of ramifications often feel undervalued and experience decreased morale. C-suite leaders who are disheartened by problems with cashflow and inaccurate reimbursement may develop resentment toward lower-level staff. Physicians who are frustrated with EHR systems may be seen as complainers whose needs go unaddressed. ![]() Without healthy systems, individuals within an organization often work against one another. To achieve a healthy organization, you must have healthy systems that serve the needs of the staff – from the leadership to the clinical teams to the IT staff – and allow all departments to work in unison. The health of an organization is just as important as the health of the patients it serves. The Complete Quadruple Aim: Healthy Systems Rather, joy in work is the desired side effect of what I suggest is the true fourth component: Healthy Systems. However, demanding Joy in Work as the fourth element of the Quadruple Aim gets us nowhere closer to achieving the balance we need. At John Lynch & Associates, I have seen first-hand how a physician’s or clinician’s experience of joy in his or her work has a profound effect on all those touched by the organization. The Institute for Healthcare Improvement – the original masterminds behind the Triple Aim – are very near to the solution. The result was several iterations of a Quadruple Aim, many of which showed promise, but none of which solved the problems of the Triple Aim. Thankfully, the astute men and women in our industry noticed the problem quickly and individual organizations got to work hypothesizing what was missing from the Triple Aim. In essence, the very nature of the Triple Aim was undermining the purpose for which it was created. Ultimately, these factors corroded the primary goals of the Triple Aim by causing decreases in patient satisfaction, decreased health outcomes, and increased costs. The Triple Aim served us well in its time, but the result was physicians working long hours, frustration with EHR systems, and burnout. With these evolutions come waves of theoretical insights that serve to guide us toward best practices and optimal outcomes. We are constantly influenced on all sides by improved technology, more effective use of population health data and analytical tools, and incremental changes in healthcare policy. ![]() The Problem with the Triple AimĪs in any industry, healthcare goes through evolutions and upgrades over time. ![]() Rather, the fourth element of the Quadruple Aim is Healthy Systems, which allow every member of the organization – in addition to physicians and clinicians – to find joy in their work, perform to the tops of their licenses, and thrive. In order to achieve the Quadruple Aim, the definition of the fourth element must expand beyond the goal of improved physician and clinician work life. I tend to agree with Feeley while taking the discussion one step further. While other organizations insist that the fourth component is Equity or Organizational Readiness, Derek Feeley, President and CEO of the Institute for Healthcare Improvement, asserts it is Joy in Work that is missing from the equation. In recent years, talk has begun to circulate of a fourth element that could bring balance to the Triple Aim. Like a barstool without a seat, the legs of the Triple Aim appeared to balance precariously for a time before clattering to the ground. However, time and time again, healthcare organizations have observed that attempts to create the Triple Aim were falling short. Physicians Thomas Bodenheimer and Christine Sinsky said it perfectly: The Triple Aim is “a compass to optimize health system performance.” The long-admired Triple Aim encompasses three principles: enhancing patient experience, improving population health, and reducing costs. Quadruple Aim: The Missing Element for Optimal Outcomes February 19, 2019
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