Triple Aim? Make that Quadruple!

The Institute for Health Improvement (IHI) Triple Aim was created to establish and pursue three main objectives1:

  1. Improve the health of populations
  2. Improve the patient experience of care (including quality and satisfaction)
  3. Reduce the per capita cost of health care

While these three objectives have been widely agreed upon, a fourth, less tangible priority has emerged that arguably affects each of the first three – and that is to create satisfaction among HCPs. While this fourth objective has been the source of some debate, growing consensus suggests that provider satisfaction is, indeed, an essential contributor to the effectiveness of the overall healthcare system. Consider these compelling insights:

Research indicates that up to 46% of US physicians experience symptoms of burnout.2 It stands to reason that physician burnout has an impact on patient care and outcomes.

In a 2014 survey, 68% of family physicians and 73% of general internists would not choose the same specialty if they could start their careers anew.3 Again, it seems reasonable to wonder whether physicians who feel professionally unfulfilled are likely to perform at their best or go the medical equivalent of “the extra mile”.

Clearly, these findings, and their likely impact, are misaligned with the intentions of the original Triple Aim – and with the inherent principles of healthcare.

One researcher at the University of Maryland found that good intentions can soothe pain, increase pleasure, and even make candy taste sweeter. Hospital patients feel less pain during a procedure carried out by “sweet natured” nurses than others.4

How much more difficult is it, then, to ease the pain of others, when health care professionals themselves are perpetually dissatisfied? That’s a powerful argument for expanding the Triple Aim to a Quadruple Aim, adding the goal of improving the work-life of health care providers, including clinicians and staff.

Whether the fourth Aim is intended to address issues of professional empowerment, financial security, organizational culture, or all of these, the purpose is clear: let’s take care of our physicians so that they can take care of us. As Market Access experts – and participants in the rapidly evolving healthcare space – we appreciate the potential impact of this critical fourth Aim. And we believe that minimizing reimbursement obstacles (an objective that we work toward every day on behalf of our clients) is a step in the right direction.

Authors: Adrienne Palmieri-Johnston with Kyi English

Sources: 1. “Triple Aim for Populations.” Institute for Healthcare Improvement, 2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–1385. 3. Bodenheimer, Thomas, and Christine Sinsky. “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider.” Advances in Pediatrics., U.S. National Library of Medicine, Nov. 2014, 4. Wood, Janice. “The Power of Good Intentions.” Psych Central, 6 Oct. 2015,