Quadruple Aim Proposed to Address Workforce Burnout

The Triple Aim: improving population health, increasing patient satisfaction, and reducing per-capita health care spending; is widely considered to be the goal of health care delivery. However, in the Annals of Family Medicine article “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider,” Thomas Bodenheimer, MD, and Christine Sinksy, MD, (2014) argue that the Triple Aim should be updated to the Quadruple Aim. They suggest the fourth aim should address clinician and staff satisfaction.

Physicians and other health workers do not have the resources to meet increased patients demands and expectations found in patient-centered medical homes, which may lead to burnout and dissatisfaction (p. 573-574).  Family physicians were among the specialties with the highest rates of burnout. Physician burnout can result in “loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment,” as well as “early retirement, alcohol use, and suicidal ideation.” Low levels of physician satisfaction can also lead to lower quality of patient care. Common factors contributing to burnout are paperwork, administrative tasks, less time spent on face-to-face activities, and increased computer and electronic health record (EHR) burdens. Other health care workers, such as nurses and receptionists, are also affected by burnout. Dissatisfaction among health care workers can contribute to and be a result of physician burnout (p. 574). Negative consequences associated with physician and health care worker burnout include overuse of resources, prescription errors, worsened clinical outcomes, and increased health care costs. Burnout also contributes to physician turnover and shortages of primary care physicians (p. 575).

Bodenhemier and Sinksy (2014) suggest a variety of methods for improving physician satisfaction. Improvements in workforce satisfaction can be achieved by using staff teams to complete EHR documentation and prescription processing. Medical assistants and nurses can be given more responsibilities for preventive care and management of chronic conditions, lessening physician workload. Adequate training for non-physician staff is important to ensure that new responsibilities do not increase burnout among other team members. Increased financial and personnel resources are also needed for primary care practices to meet the fourth aim (p. 575).

Maintaining a balance between workforce satisfaction and patient satisfaction will be critical in achieving the fourth aim. Reductions in physician and staff burnout will support the primary goal of the triple aim, improving population health.

View the journal article (PDF - 475.03 KB).

Posted March 2015