From Triple Aim To Quadruple Aim

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance.

Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs.

Burnout thus imperils the Triple Aim. The Quadruple Aim though improves the work life of health care providers, including clinicians and staff. How can health care organizations work toward the fourth aim, improving the work life of clinicians and staff?

For primary care physicians the following list suggests some practical steps:

1- Implement team documentation: nurses, medical assistants, or other staff, present during the patient visit, entering some or all documentation into the EHR, assisting with order entry, prescription processing, and charge capture. Team documentation has been associated with greater physician and staff satisfaction, improved revenues, and the capacity of the team to manage a larger panel of patients while going home earlier.

2- Use pre-visit planning and pre-appointment lab testing to reduce time wasted on the review and follow-up of lab results.

3- Expand roles allowing nurses and medical assistants to assume responsibility for preventive care and chronic care health coaching under physician-written standing orders.

4- Standardize and synchronize workflows for prescription refills, an approach which can save physicians 5 hours per week while providing better care.

5- Co-locate teams so that physicians work in the same space as their team members; this has been shown to increase efficiency and save 30 minutes of physician time per day.

6- To avoid shifting burnout from physicians to practice staff, ensure that staff who assume new responsibilities are well-trained and understand that they are contributing to the health of their patients and that unnecessary work is re-engineered out of the practice.

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