The Quadruple Aim
Dr. Don Berwick and the IHI have long advocated for the Triple Aim - improving the U.S. health care system through the simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.

As the crisis of burnout in physicians, nurses, and other health care workers has worsened, many leaders are calling for a change to the Triple Aim to include care giver wellbeing, expanding it to the "Quadruple Aim."

This simply makes sense.
  • Burnout is an access issue. As burnout worsens, physicians and nurses are limiting their work hours or quitting medicine altogether, reducing access to care.
  • Burnout is a patient experience issue. Burned out care givers have less empathy to give to their patients.
  • Burnout is a quality and safety issue. Those who are actively seeing patients while feeling burnout have lower resilience, and as a result are less well able to notice early changes in patient status or respond to emergencies.
  • Burnout is a financial issue. When physicians reduce their work hours the infrastructure costs that support them are unlikely to decrease concomitantly. When a doctor leaves the practice, the cost of replacing them is between $250,000 and $500,000, depending on the specialty.
  • Burnout is a human issue. It is unconscionable that we allow highly mission-driven professionals who have sacrificed and dedicated their lives to caring for others to work in the chaotic stressful conditions that exist in most health care settings today.

Lean done right, based deeply in the Lean principle of Respect for People, results in workflow redesign and management structures that remove the barriers and frustrations that lead to burnout, and allow clinicians to focus on the most important person in the organization – the patient.

If you would like to learn more, feel free to contact me. I am happy to help.
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