The Battle for the Quadruple Aim - Its 3 on 1 and the Outcome Is Unclear

Posted by Dike Drummond MD

quadruple-aim-physician-burnout-battle_opt150W.jpgThe Battle for the Quadruple Aim - It's 3 on 1 and the Outcome Is Unclear

The Quadruple Aim is a simple, common sense concept that goes like this:

Quality patient care is based on the health and wellbeing of the human beings providing that care ... the doctors and staff. 

I know ... you are probably saying "Duh" right now. It seems like such an obvious statement of fact ... right? And it is such an obvious antidote to physician burnout.

I must admit I  had a naive assumption that this concept would take off like a rocket after the first article in Annals of Family Medicine in 2015. And it has not. 

The Quadruple Aim is actually a radical notion in the healthcare industry for three distinct reasons I will show you below.

The battle lines are drawn and the forces are in raging conflict in C-suites and Board Rooms across the globe.

Unfortunately the outcome is in doubt at this point in time.

Learn the Skills of a Physician Wellness Champion at the
Quadruple Aim Physician Leadership Retreat
CLICK HERE to Learn More NOW

How in the world did we get to this point?

Remember, our current reality is a result of 20 years of cracking the whip of the Triple Aim. Our modern epidemic of physician burnout and the lives lost along the way --  both patients and doctors -- have taught a select group of physician leaders an important lesson. 

If all you focus on is the old Triple Aim

  • Cost

  • Quality

  • Population health

... the Only Thing You Are Guaranteed is an Epidemic of Physician Burnout 

That mission has been accomplished. 

The Quadruple Aim offers us an opportunity to right this wrong for a small, select group of healthcare organizations - those that care enough about their people to invest in preventing physician burnout.

 The Quadruple Aim Blueprint Strategy
CLICK HERE for FREE Download 

The Field is Now Set
The Quadruple Aim Faces a Powerful Triad of Adversaries

1) Profit
2) Big Data 
3) The Massive Blind Spot Caused by the Conditioning of Our Medical Education

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1) Profit

healthcare-profit-vs-the-quadruple-aim-physician-burnout.jpgRealize it takes time, energy and yes ... a financial investment, to take better care of your people. Up until this point, healthcare organizations have simply heaped additional tasks on the doctor's backs without paying any attention to the cumulative stress this causes.

  • Just asking the doctors to do more is much less expensive than staffing adequately. The doctor's quality of life is systematically sacrificed for short-term profits.
  • Until recently it quality care and patient satisfaction had zero impact on the Profit and Loss Statement. Now we can show comprehensive ROI with clear financial impact on the bottom line.

To launch a Burnout Prevention Working Group is a new experience for every healthcare organization. Simply having such a committee is not enough. If you don't staff and fund this new team adequately, you will just burn out out its members.

Leaders stare at me with disbelief when I tell them this Working Group and this initiative to take better care of your people is a permanent fixture of your physician leadership going forward.

If your organization is profitable and yet will not fund a Burnout Prevention Working Group and its initiatives, they don't understand the Quadruple Aim and simply do not care enough about the physicians and staff.

It is not enough for leadership to give lip service to caring about their people.

  • Write a check.
  • Put burnout prevention in the budget as a standing item going forward. 

When it comes to investment in the doctors, leadership usually will fall back on two objections:

We have never done anything like this before
Meaning = Can't we just give them some resilience training and call it good? (check the box)

We don't have the money - there is no space for this in the budget.
Meaning = This is not a priority at this time

As physicians and leaders, we cannot allow the senior leadership team to keep trotting out these lame excuses and fail to address burnout systemically. If your organization doesn't "get it" despite your best efforts to raise their awareness and build a case for doing things differently, it may be time for a job change. 

Remember the ROI on Burnout Prevention is Comprehensive:

  • Better quality of care
  • Fewer errors and malpractice suits
  • Higher satisfaction for patients, staff and physicians
  • Lower turnover for physicians and staff
AND in our modern payment environment, every one of these roll to the bottom line in any organization who invests in the health and wellbeing of their people.

The Quadruple Aim will be More Profitable in the Long Run

And will require additional investment in your people in the short term.

Only a small minority of visionary organizations will understand and act on this new reality. Make sure one of them is your employer.

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2) Big Data

The blind pursuit of Big Data via it's Zombie Accomplice - your EMR system - is literally choking out patient care. 

quadruple-aim-stop-physician-burnout-big-data.jpgThe documentation tasks of the front line providers overwhelm the doctors and staff with entry level data entry work. All EMR systems interfere with quality patient care and divert massive amounts of money from the actual care of patients in the name of some future BIG DATA payoff we have yet to realize.

Adding to the EMR insult, most healthcare organizations staff to MGMA Averages rather than the actual workload

A recent study showed doctors spend 2 hours on computer work for every hour of direct patient care. Another recent study showed we can staff up to meet the tasks of documentation, but you would have to be ready to defy MGMA averages to get there.

Big Data / EMR / and Understaffing work synergistically with our programming (see below) to destroy the quality of life for many physicians.

Stop the conflation of Big Data/EMR and Physician Burnout. This is not an unavoidable association.

All it takes is to staff appropriately and move towards true team based care as quickly as possible.

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3) The Programming of our Medical Education

Why caring about the physicians and staff is a revolutionary idea - and why it took 20 years to unseat the burnout producing formula of the Triple Aim in healthcare -  is a testament to the power of the programming of our medical education

We learn to ignore our own needs in training as we are conditioned to be 

  • Workaholic
  • Lone Ranger
  • Superhero
  • Perfectionist

... and rigorously adhere to healthcare's two prime directives;

  • The patient comes first 
  • Never show weakness 

And the entire healthcare industry shares this blind spot.

Until now, organizations have simply piled anything and everything on the backs of the physicians and staff with no acknowlegement that there may be a limit to our ability to cope. More and more clicks, emails, texts, EMR, Meaningful Use, HCAHPS and Press Ganey -- shoveled on the backs of the doctors and staff.

The rise in physician burnout rates in the last several years are a sign we have reached the limit of our tolerance. Even residency survivors like us have our limits.

Until now our programming has driven us to simply take on everything shoveled our way. We have reached the tipping point where that is no longer possible.

Then there is the Millennial Effect

New residency graduates accustomed to work hour restrictions are causing wholesale change in the definition of  what is contained in the 1.0 FTE Job Description in many healthcare organizations. The results is that doctors are rapidly moving away from the life crushing workloads of the past and the doctor shortage is worsening. 

We are stuck in Einstein's Insanity Trap
Something has to change
We have the tools for this transformation in hand 

It is up to the physician's employer to complete their medical education with regards to the recognition and prevention of burnout, teach boundaries, balance, leadership skills and more. We must work together to build the physician of the future where a full practice and the highest quality care is compatible with a rich and fulfilling life.

The Eventual Winner of this Battle is Unclear

Profits and Big Data and Our Programming
the Quality of Life of the People Providing the Care

I believe the Quadruple Aim will prevail AND there are long days of uncertainty and confusion ahead.

It is us and our abilities as Physician Leaders - working inside organizations who understand and respect the Quadruple Aim - that will win out in the end.

There has been an enormous pendulum swinging in favor of the Triple Aim in the design of the systems of care.  Until now.

That Pendulum is Swinging Back in Favor of the Providers - in a Very Selective Fashion

"Selective" because it is still rare for an organization to "Get" the Quadruple Aim and rarer still to wield it with the same respect as the tenents of the Triple Aim.

Related: The Quadruple Aim Blueprint Strategy
CLICK HERE for FREE Download 

As I train around the country and ask rooms full of doctors and physician leaders what they know about the Quadruple Aim ... the simple awareness of the concept is uncommon. Often less than 20% of the room will raise their hands signifying that they know what the term means. 

I must admit I  had a naive assumption that this concept would take off like a rocket after the first article in Annals of Family Medicine in 2015. And it has not. 

It is up to us to use the common sense and logic of the Quadruple Aim as a lever to re-establish physician leadership in organizations where that is possible. This transformation will only happen in a small minority of organizations.

I suspect the percentage of groups that will ultimately install the Quadruple Aim in "the way we do things around here" will be around 10%. 

And I have faith that those 10% will deliver care, performance, engagement and quality in a way that establishes the Quadruple Aim as a massive competitive advantage in the years ahead. 

Learn the Skills of a Physician Wellness Champion at the
Quadruple Aim Physician Leadership Retreat
CLICK HERE to Learn More NOW


Is your organization one that understands the Quadruple Aim and is doing something about it?

Tags: stop physician burnout, quadruple aim