Quadruple Aim: The Missing Element for Optimal Outcomes

February 19, 2019

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.

However, time and time again, healthcare organizations have observed that attempts to create the Triple Aim were falling short. Like a barstool without a seat, the legs of the Triple Aim appeared to balance precariously for a time before clattering to the ground.

In recent years, talk has begun to circulate of a fourth element that could bring balance to the Triple Aim. 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.

I tend to agree with Feeley while taking the discussion one step further. 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.

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.

The Problem with the Triple Aim

As in any industry, healthcare goes through evolutions and upgrades over time. 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.

With these evolutions come waves of theoretical insights that serve to guide us toward best practices and optimal outcomes. The Triple Aim served us well in its time, but the result was physicians working long hours, frustration with EHR systems, and burnout. Ultimately, these factors corroded the primary goals of the Triple Aim by causing decreases in patient satisfaction, decreased health outcomes, and increased costs.

In essence, the very nature of the Triple Aim was undermining the purpose for which it was created.

The Solution of the Quadruple 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.

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.

The Institute for Healthcare Improvement – the original masterminds behind the Triple Aim – are very near to the solution. 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.

However, demanding Joy in Work as the fourth element of the Quadruple Aim gets us nowhere closer to achieving the balance we need. Rather, joy in work is the desired side effect of what I suggest is the true fourth component: Healthy Systems.

The Complete Quadruple Aim: Healthy Systems

The health of an organization is just as important as the health of the patients it serves. 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.

Without healthy systems, individuals within an organization often work against one another.

Physicians who are frustrated with EHR systems may be seen as complainers whose needs go unaddressed. C-suite leaders who are disheartened by problems with cashflow and inaccurate reimbursement may develop resentment toward lower-level staff. Administrators who are afraid to speak up about problems for fear of ramifications often feel undervalued and experience decreased morale.

These are the red flags that individuals become numb to in their day to day work that actually signal a large problem with the health of the organization as a whole.

However, by improving the way of life within an organization from the ground up – starting with the systems that form the foundation of every individual’s daily tasks – we can create positive, lasting changes.

If you have questions about how to achieve the Quadruple Aim within your healthcare organization, get in touch with us. We will help you put a plan in place to ensure your systems are a source of joy and relief rather than frustration and doubt.

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