The Quadruple Aim Mission Statement Challenge

Posted by Dike Drummond MD

physician-burnout-mission-statement-quadruple-aim-150W.jpgThe Quadruple Aim Mission Statement Challenge

Is your organization focused on the Triple Aim or the new Quadruple Aim ... and what impact can you expect on your quality of life?

This 30 second peek at your Mission Statement will show you just how much your organization understands burnout ... and cares about you ... and what you can do about it.

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Remember the old Triple Aim in Healthcare?

1) Cost
2) Quality 
3) Patient Experience / Population Health

This three pronged approach to improving healthcare delivery was first promulgated by the Institute for Healthcare Improvement (IHI) back in the 1990's.

As we look back on from our vantage point here in 2016, at the changes this initiative has brought to healthcare, there appears to be a large red flag waving frantically over the house of medicine. We know now that ... 

The Triple Aim is built of noble ideals
The Triple Aim has had ruinous unintended consequences

If all you focus on is quality, cost and patient satisfaction ... you burn out the people providing care. 

Single minded focus on the Triple Aim without acknowledging the health and well being of the physicians and staff providing care is a three lane on-ramp to the burnout highway.

We know the doctors are suffering and things are getting worse. The latest general physician burnout survey shows 54% of US doctors are experiencing at least one symptom of burnout. This is up from 45% just three years ago. There is no reason to think nurses and other staff members are any better off.

Enter Healthcare's New QUADRUPLE AIM

1) Cost
2) Quality 
3) Patient Experience / Population Health
4) AND ... Optimizing the health and wellbeing of your clinicians and staff

The Quadruple Aim adheres to the worthy goals of the Triple Aim and honors the fact that real live people are delivering the care. The health and well being of the providers and staff are brought into the equation to restore balance and humanity to the system. 

Here is a PDF of the Annals of Family Medicine Article outlining this radical new concept.

Does your organization understand the Quadruple Aim?

There are two ways to tell:

Quad Aim Physician Leader Retreat

1) Take the Quadruple Aim Mission Statement challenge

Grab your organization's Mission Statement.

You will probably have to dig a little to find your Mission Statement. (... no matter how many times I hear the pronouncement, "We are Mission Driven", it is rare to see a company that puts their mission up front and lives it) I suggest you look on your organization's website.

Got it? Good. Now take a good, long look ... 

Does the health and well being of the physicians and staff get any mention at all in the Mission Statement of your organization?

  • In my experience, 95% of organizations that employ physicians make no mention of the docs and staff in the Mission Statement
  • All of them will mention the majority of the Triple Aim components

If the health and well being of the doctors and staff are not in your Mission Statement you are potentially in trouble.

There is nothing stopping your leadership from sacrificing your health and well being along the road to the Triple Aim if they choose to do so.

If you don't appear in the Mission Statement you have no cover. You cannot be legitimately disruptive; raising your concerns about workload and burnout because your Mission Statement holds provider health as an important priority.

Your interests come last.

For a refreshing, logical and counter-intuitive look at this whole subject of healthcare priorities, I highly recommend the book, "Patients Come Second". I consider it required reading for all healthcare leaders.

2) Simply look at how your group makes decisions

When your organization is rolling out new systems and responsibilities do they ever take into account the extra workload, time commitment and stress this new mandate places on you or your staff?

Or is their motivation focused only on quality, cost or patient satisfaction or some other ideal like safety or profit?

The motivation behind a change in the workplace routine reveals your leadership's priorities.

Look at the last initiative your group dropped on your practice - it might have been a new EMR or PCMH or taking on a procedure or referral source - whatever that last change was ...

  • What was the intention of that mandate? Was it income, quality, safety, patient satisfaction? 
  • Did they acknowledge your existing workload at some point along the way or are you simply expected to magically squeeze this into your day with no additional time in your schedule or additional staffing to handle the new tasks?

fundamental currency

Does the emergence of the Quadruple Aim mark an Inflection Point 
- in the Healthcare Industry?
- in Your Organization?

It is our responsibility to fan this spark into a flame that changes the organizations who care about their physicians and staff.

There appear to be people in the industry who finally grasp the importance of the health and well being of the workers.  Here at we will be shouting from the rooftop about the Quadruple Aim from this point forward. Can this new awareness catch on and become the standard of leadership in the healthcare industry?

Know this:

  • The Triple Aim is old thinking. Anyone who continues to trot it out as state-of-the-art is behind the times and needs to understand its disastrous effects on the workforce.
  • The Triple Aim is only sustainable when it is upgraded to the Quadruple Aim
  • Organizations who take better care of their people will develop a massive competitive advantage in the near future
  • Happier, healthier doctors deliver higher quality care, with better patient satisfaction and are more engaged in their organizations. These changes happen naturally and automatically when you take better care of your people.

If that is not enough motivation, let's look at what happens if the industry continues down this crazy train of Einstein's insanity trap.

If we continue to ignore the health of the workers in the system, everyone can see the trajectory we are on and the inevitable end point. It is time for this pendulum to swing back towards some sanity and respect for the workers in the system.

For a taste of what complete overload looks like, just dive into the 2014 burnout survey noted above and you will see that 7.2 % of doctors experienced suicidal ideation in the last year compared to 4% in 2011. My math says that is an 80% increase. In addition, 39% of the doctors screened positive for depression. These findings shock me. Your thoughts?

physician-burnout-quadruple-aim-action-steps_opt300W.jpgACTION STEPS:

1) If you have a Quadruple Aim Mission Statement ...

Make sure your organization lives it.

Share the Quadruple Aim study with your colleagues and leadership. Build time, stress and energy checks into the approval  process for any new mandates or systems placed on the physicians or staff. The questions are simple.

Here's are a few examples:

  • "Before we implement this program let me ask, what impact will this have on the time, energy or stress levels of the physicians and staff?"
  • "If we are asking our people to do these additional activities, what shall we have them stop doing to make this a zero sum?"
  • "How are we going to staff up to handle these additional responsibilities?"

2) If you and the staff are conspicuously absent from the Mission Statement

Push for an organization-wide retreat to build a new Mission Statement and Strategic Plan.

Make sure to restore balance to the force by honoring the Quadruple Aim in your organization going forward. Build in the questions above into the approval of any new systems going forward.

3) Watch out for this pattern:

  • You notice the group makes decisions that keep upping your workload and responsibilities and taking away your flexibility with no acknowledgment of your quality of life
  • They do not care about the health of the people providing care and are not open to the message of the Quadruple Aim
  • They are not willing to re-evaluate the Mission Statement

If you are burning out in an organization like this ... polish up your Ideal Job Description and strongly consider finding a new practice. This is especially true if you have had a partner or two leave in the last six months.

Do NOT be the last rat off a sinking ship.



Is your organization Quadruple Aim savvy?
Do you appear in your Mission Statement?


Tags: Physician Burnout, quadruple aim