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Healing the healers: The quadruple aim approach to wellness


As a year comes to a close and another opens to new possibilities, many find themselves contemplating their successes and opportunities for improvements. The holidays are very busy, and the new year brings hope to slow down and reset. For many health care providers, though, the prospect of slowing down is an unrealistic dream.

For many in health care, the profession is not just a career, but an honorable vocational calling. The dozen or more years of training were arduous but worthwhile. The work ignited our passions and brought joy. However, after 15 years or so many find the joy fading. The reality of 12-hour shifts, 36 or more patients a day, charting and responding to patient messages after hours, etc. is exhausting. It limits time and energy for family, self-care, and other responsibilities. In short, health care professionals are increasingly burned out.

Burnout is an occupational syndrome that results from prolonged levels of high stress leading to decreased effectiveness at work. Burnout can affect anyone. According to Psychology Today, 52 percent of Americans are burned out, and health care providers are not immune. in Burnout, health care providers have increased since 2021, with 53 percent of physicians reporting that they are burned out. Unfortunately, 1 in 5 physicians plan to exit medicine within two years, and it is predicted that there will be a shortage of up to 139,000 physicians by the year 2033.

Provider burnout is associated with negative clinical outcomes, lower levels of empathy, medication errors, and medical errors. Physicians who report signs of burnout make more errors and are twice as likely to have made a medical error in the previous three months.  According to Christina Maslach of the University of California, Berkeley, the top 3 causes of burnout are:

1. Unsustainable workload. Too many patients, 15-minute appointments, and additional hours documenting charts at the end of the day. Little to no time to eat or go to the bathroom.

2. Lack of control and lack of autonomy result in impacted appointment schedules, rigid start and end times, and little flexibility for family or children.

3. Lack of recognition. Despite exceedingly high levels of expectations for today’s health workforce, there is very little positive feedback or recognition.

The result: Patient safety is threatened and patient satisfaction is lowered.

However, one of the biggest challenges in health care is not individuals but the system. Specifically, the Triple Aim business model is a guide to optimizing health care system performance. The Triple Aim highlights:

  1. Enhancing patient care
  2. Improving health outcomes
  3. Managing costs

Providers are not part of this equation!

Patients are best served by an expert provider whose humanity, intuition, and compassion: All combine to provide the best care. Medical care, at its core, is supposed to be personal, integrative, healing, and restorative. Yet, the goals, processes, and policies that protect the Triple Aim business model fail to include the human needs of the ones providing the care.

In May of 2022, the U.S. Surgeon General issued an advisory for the urgent need to support our health workforce. In response, and in isolated places, proactive programs and systems are being implemented to support health care providers. Vanguard Hospitals are leading the way. They are now operating under a revised business model called the Quadruple Aim, with the addition of a new fourth quadrant that prioritizes health care team well-being. The Quadruple Aim is the beginning of a sustainable recipe for provider wellness.

To ensure health care teams get the support they need, Vanguard Hospitals have created a new role: chief wellness officer. This is a physician leader in an administrative role, whose goal is to advocate for preventative health systems that support the wellness of those providing care. Leading institutions, like Stanford, Duke, the Mayo Clinic, and the American Medical Association, are committed to producing research-based protocols that health care organizations across the country can implement to tackle physician burnout.

Such a revised model is a ray of hope, but every health care system needs a business model that emphasizes health team wellness and a tangible structure that makes it happen.

However, as with any treatment plan, there are smaller, holistic steps that our medical profession could take:

  • Providers need intellectually stimulating environments like health policy think tanks where they can share ideas and discuss the latest trends in medicine, similar to the structure of the RAND Corporation.
  • Providers need scheduled social events that cultivate human connection.  Peer relationships make us stronger and remind us we are not alone. In the words of the Hippocratic Oath, “Collegiality unites us in preserving the finest traditions of our calling, as we experience the joy of healing those who seek our help.”
  • Providers need to take time off. One-third of physicians take no more than two weeks of vacation each year. Time off increases well-being, performance, and productivity.

Provider burnout is a fixable crisis. We challenge all health care institutions to adopt and operate under the Quadruple Aim model, which holds each organization accountable to create a plan for provider wellness – for their benefit and for patient wellness.

Providers are human. A dose of humanity and gratitude will go a long way. Today’s recipe for medicine needs to evolve to produce more appealing results. The missing ingredient? Provider and health care team wellness, on and off the job. Providers need the same preventative concern and care that we provide to our patients. It can be done! Let’s keep the fire burning and bring joy back to medicine. This will provide the best health care.

Nicole Alexander-Spencer and Jessica L. Jones are family physicians.


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