Quadruple Aim - is it the antidote to Physician Burnout?

Posted by Dike Drummond MD

quadruple-aim-physician-burnout-medicine-healthcare-annals-of-family-medicineQuadruple Aim - is it the antidote to Physician Burnout?

[related: Physician Leadership Dirty Little Secrets]

Physician Burnout is the Rodney Dangerfield of issues confronting our rapidly changing healthcare environment

It get's no respect ... at least until now.

In a dramatic mainstream journal article published in the latest issue of Annals of Family Medicine, the authors have proposed using Physician Burnout to redefine the Institute for Healthcare Improvement's Triple Aim for healthcare.

Here is the Triple Aim:

  • Enhancing the patient experience
  • Improving population health
  • Reducing costs

I hope you can see the blind spot in this three part formula

Let's listen to the authors state what should have been blatantly obvoius from the start ... 

They note:

"In visiting primary care practices around the country, (we) have repeatedly heard statements such as, “We have adopted the Triple Aim as our framework, but the stressful work life of our clinicians and staff impacts our ability to achieve the 3 aims.”

These sentiments made us wonder, might there be a fourth aim—improving the work life of health care clinicians and staff—that, like the patient experience and cost reduction aims, must be achieved in order to succeed in improving population health?

Should the Triple Aim become the Quadruple Aim?"

Right Question ... Simple Answer ... "YES"!!

The Quadruple Aim Blueprint White Paper Download
Four Steps to System-Wide Burnout Prevention
Download your Free Copy Now

It seems simple to understand that you cannot build a system to provide healthcare and be blind to the health and happiness of the people providing the care. There is a gaping hole in Triple Aim ... and the authors of this study have nailed it.

By concentrating only on these three principles - and completely missing the fourth principle hiding in the shadows -  we created a system where surveys consistently show one in three doctors suffer from symptomatic burnout on any given office day. 

The following two principles will always be true


1) You can't give what you aint got

The patient cannot always come first if you are going to be a good doctor. When you are in front of the patient, they come first. When you are not on duty, you must put yourself and your loved ones first or physician burnout is inevitable.

Unless you balance your priorities, you rapidly deplete your energy accounts. You eventually have nothing to give the people who need you the most - your patients, your staff and your family. You simply cannot give what you aint got!

quadruple-aim-physician-burnout-dike-drummond2) It takes happy doctors have happy patients

It is not a conundrum along the lines of "which came first, the chicken or the egg"! This is a linear equation, just like third grade arithmetic. 

How can you expect your patients to give you a "5" on their satisfaction survey today - if you asked the physicians to rate their satisfaction with their practice ... and they gave it a "3"? Not possible. 

Only happy healthy providers can produce happy patients. When the doctors and staff are happy, patient satisfaction comes naturally. The Quadruple Aim is really that simple.

fundamental currency

Let's state the obvious about physician burnout

In the age of patient centered care, the most inportant determinant of 

  • Patient satisfaction
  • Quality of care
  • Probability of a medical error

is the level of physician burnout in your doctor at the moment they close the exam room door to begin your visit.

It is time Healthcare Delivery Organizations take some responsibility

In this age of employee physicians, it is time for the employing organizations to take responsibility for the conditions of the workplace and begin to proactively address the stress their systems put on the front line providers.

  • Doctors / NP's / PA's
  • Nurses, medical assistants, receptionists
  • Front line administrators
  • Anyone who is at risk of DNA transfer from a patient in the normal performance of their job description

The typical physician burnout rate of 1 in 3 is completely unacceptable and totally avoidable

Here at TheHappyMD.com, our mission is to give you the tools to act on this fourth aim ... whether you are an individual doctor or a leader in your organizaiton.

Here are over 235 ways to prevent physician burnout

Here is a step by step manual to de-stress the workplace starting today

This is a resource every physician should be given by their employer and every medical school and residency program should have as a standard part of the curriculum.

It is time to take massive action to change the culture of healthcare with regards to burnout

I sincerely hope this new quadruple aim is a significant first step.

  • It is time to eliminate the lone ranger, superhero, workaholic physician ideal and humanize the environment where we heal the sick, wounded and dying
  • It is time to build a supportive environment for the caregivers in our medical education system rather than continuing the previous generations' gladiator survival contest mentality

Bring on this new Quadruple Aim

Let's systemize it ASAP. It is the first step to caring about the people in the system as much as we care for the patient. Game on I say.

The Quadruple Aim Blueprint White Paper Download
Four Steps to System-Wide Burnout Prevention
Download your Free Copy Now

What say you?



Here is a link to the online full text article:

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider
Thomas Bodenheimer Christine Sinsky, MD


Here is the full PDF article for your review



Tags: Physician Burnout, quadruple aim