The Quadruple Aim: Why providers must put the fourth target first

Several years ago, I was living in one of the so-called better parts of a city somewhat notorious for its miscreants. It didn't take long for the effects of crime and desperation to seep into our starter home, however. The first car break-in came as a shock, as did the first home invasion and attempted car theft from our driveway.

But after a year or more of having our boundaries violated, possessions stolen and bearing our share of victim-blame for having the gall to sleep with a window cracked, we started to become desensitized. I realized this the day I got in my car to find the glove box ajar and ransacked, yet again, and didn't bother to call the police. I had to get to work, and reporting the incident wasn't going to do any more good than it had the first 20 times.

Every time I read another study about professional burnout in healthcare, I find myself as an editor wrestling with the question of whether readers will consider these ever-more astonishing statistics news, whether they'll pause to read the grisly details or just keep moving.

Has burnout become so pervasive and normalized that the healthcare industry has stopped sounding the alarm?

I sure hope not, but at the same time I understand the human tendency to tune out a seemingly unsolvable problem as it escalates to outrageously dangerous levels.

It took a broad-daylight stabbing at a nearby park for my family to pack up and sell a house we loved, for a loss. And statistics tell us that economics and regulatory pressures increasingly push physicians to abandon their profession--and stress and other pressures can lead them to take their own lives.

Healthcare professionals, altruistic as they are, have the same needs as anyone else to self-preserve. But just as neighborhoods need champions to take action for deep-seated problems to turn around, so too do organizations, institutions and professions.

Healthcare needs more champions for the Quadruple Aim--people who are ready to tackle worker well-being as a prerequisite to the goals of improving care, boosting population health and lowering costs--not an add-on when and if they get around to it.

It is a shared responsibility to create work-lives that are not just survivable but mostly satisfying and pleasant. If physician practices as we know them are to thrive, healthcare professionals need to speak up and organizations must listen.

The trouble spots to address will vary by clinician and by practice; but areas to prioritize and humanize include the following:

  • Productivity targets
  • Compensation formulas and transparency
  • Opportunity for rest and recovery
  • Respect for family and personal lives
  • Efforts to remove stigma from mental illness and substance-use disorders
  • Communication and teamwork
  • Practice cultures that promote trust through support rather than authority

It may sound idealistic, but to keep healthcare employees healthy and engaged, they need to be able to come to work at least most days feeling aligned with their true north, as Linda Burnes Bolton, vice president for nursing, chief nursing officer, and director of nursing research at Cedars-Sinai Medical Center in Los Angeles and healthcare leadership champion, explained to me in one of the most unforgettable interviews of my career.

In another way of looking at it, if work is going to be a person's second home, it should feel just as safe and supportive. Healthcare neighborhoods are in danger of an exodus if they don't organize to fight back against burnout. - Deb (@PracticeMgt)

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