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Who Cares?
Caring for the Caregiver – the Fourth Aim in the Quadruple Aim


Previously published in CAPsules

by Carole A. Lambert, MPA, RN
Vice President, Practice Optimization, Cooperative of American Physicians, Inc.

The Triple Aim – enhancing patient experience, improving population health, and reducing costs – has been widely adopted as a set of principles for healthcare reform not only in the US but also within many organizations around the world. The successful achievement of the Triple Aim requires a highly effective healthcare organization with an engaged and productive workforce – clinicians and staff who have a sense of accomplishment and meaning in their contributions. Recognizing that more and more is expected – if not demanded – of clinicians and staff, it has been urged that we modify the Triple Aim to the Quadruple Aim and add improving the experience of providing care as the fourth aim.

Reflecting on the Quadruple Aim, we see parallels in the patient, physician, staff and organizational trajectories, trajectories that are traveling through an environment of regulatory demands, financial constraints, and human fallibility.

We search for meaning in receiving and providing healthcare. Why has the treatment or medication been ordered? Why does it matter? Who will it affect? What will it cost? Will it change anything? What do we hope for? What do we fear? The work has meaning beyond the task – a shared understanding of the work is a bond among physicians, patients, staff and organizations. We want a sense of accomplishment – that we are acting rather than reacting, taking steps, making changes. Calling on our experience and expertise, being focused but flexible in responding, we are constantly learning, setting a tone of partnership among the members of the healthcare team. We hope for a feeling of belonging – for identity, respect, courtesy, reliability, predictability – for safety. We want to be seen, known, listened to. We would like as few surprises as possible – unless they are really good surprises! We would like people to do what they say they will do. The challenge to physicians, patients, staff and organizations, is to work together to create and maintain a healthy supportive workplace in the area, however small or large that we manage. We are unavoidably joined together in this enterprise, using the resources at hand to care for and protect patients, physicians, staff and our organizations.

We can begin by ensuring that we are mobilizing communication in all its forms, providing information and education to empower, and hold accountable, and receive feedback from every member of the team. We can set standards of performance and behavior and provide patient education and staff training and development to implement and reinforce them. We can be relentless in our attention to detail, to an ongoing critical evaluation of systems and to their consistent implementation.

In such a dynamic environment, physicians, patients, staff and organizations can share a sense of pride in their care of and for each other, making the Quadruple Aim a reality.



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About the Author

Carole has been working in the areas of patient safety, risk management and loss prevention, quality and compliance, and organizational development throughout her career. At the Cooperative of American Physicians, Inc. (CAP), Carole uses her experience and expertise to identify opportunities for supporting the physician members of CAP. She also directs CAP’s Residents Program, a four-tier program of risk management and professional education that is presented at medical centers throughout California, and which began its ninth year in August 2017.