While these intervention strategies can foster improvement related to the targeted issue, they often fail to address the root causes of stress and burnout, and may be a temporary fix for organizational problems that will eventually return. For example, interventions such as mindfulness and stress management are often used to improve the well-being of the healthcare team. Despite this, interventions tend to target one specific problem rather than comprehensively targeting the challenges experienced in primary care. These competing demands contribute to the burden that healthcare professionals are experiencing today, likely encouraging moral distress and burnout and creating a cycle that makes it even harder to provide high-quality care. These burdens trickle down within teams, creating a stressful environment wherein team members must work with administrative tasks instead of focusing on patient care. Despite these pressures, physicians are also dedicated to providing quality care to their patients. Many physicians spend hours of overtime completing EHR and other administrative tasks. These include expectations of physicians to generate wRVU by seeing more patients, suboptimal design of the EHR (electronic health record), shifting patient/consumer expectations of the provider-patient relationship, and a rapidly increasing alternative primary care sector, e.g., walk-in clinics, urgent care, concierge medicine, and online offerings. There are an increasing number of forces that create demands on providers’ performance and cognitive load. Thus, healthcare systems are facing 2 daunting yet seemingly opposed challenges: striving to achieve the goals proposed in the Quadruple Aim while increasing productivity. Most private insurers mimic this productivity-based reimbursement strategy. Reimbursement for care provided in the United States is based on productivity, i.e., work relative value units (wRVU), despite a shift towards value-based care by the Centers for Medicare and Medicaid Services. These foci are crucial for healthcare quality, yet healthcare systems must also consider other factors. These performance dimensions can be applied to far-reaching, crucial healthcare challenges, such as reducing the massive rates of burnout present in healthcare workers and combating rising healthcare costs. The framework encompasses reducing costs, improving population health and patient experience, with a new fourth domain: healthcare team well-being. In 2014, the Quadruple Aim-adapted from the widely-accepted Triple Aim -was suggested as a framework to optimize healthcare system performance.
A larger-scale study over a longer time period is needed to confirm findings and examine feasibility and cost-effectiveness. These preliminary results support the feasibility of introducing substantial process changes that show promising improvement in both the Quadruple Aims and productivity.
The intervention group offered 48% more patient slots than the average reference team. Compared to the reference team, the intervention team performed better in all Quadruple Aims and productivity measures. Clinic output data were retrieved for 467 visits. In total, 46 team surveys and 156 patient surveys were collected. Study outcomes were measured via provider/staff and patient surveys and administrative data. The five remaining providers and their teams comprised the reference group, who continued patient care as usual. One provider and their team implemented an efficiency-focused intervention that modified work roles and processes focused on utilizing all team members’ skills as allowable by applicable licensure restrictions. Participants were 25 employees and their patients in a primary care clinic.
This quasi-experimental pilot study tested a 2 week intervention aimed to address the Quadruple Aims while improving productivity. Healthcare is battling a conflict between the Quadruple Aims-reducing costs improving population health, patient experience, and team well-being-and productivity.
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