Last month, during our seminar, Reinventing Your Organization In A Complex Market: A Guide To Building A Sustainable, Performance-Driven Organization, at The 2016 OPEN MINDS California Management Best Practices Institute, we had a great discussion about strategy in an era of value-based care – and of strategy implementation. Key to making every strategic initiative a success is having the right team in place, and getting that team invested in making your strategy a success (see For A Team Effort, First You Need The Team and Fitting Management Team Development Into Your “Real Work”). This point brought up an interesting concept that I’ve been reading more about – the unexplored fourth pillar of the “Triple Aim” of health care, referred to as the “Quadruple Aim.”
We have all heard of the “Triple Aim” – the widely held goal to improve the health of populations by improving the consumer experience, improving the quality of care for consumers, and reducing (or at least controlling) the per capita cost of health care (see Data > Information = Population Health Management and The Triple Aim for Accountable Care Organizations: What Needs to Happen & How Does Your Organization Participate?). The term was coined by Donald M. Berwick, Thomas W. Nolan, and John Whittington (see The Triple Aim: Care, Health, And Cost) – and the “goal” of the Triple Aim is a key piece of the framework for value-based purchasing (see ACOs & Hospitals – The Changing Landscape).
Then, in 2014, the Triple Aim evolved into the “Quadruple Aim.” A 2014 Annals of Family Medicine paper suggested adding a fourth pillar – the satisfaction of direct care clinicians and professionals (see From Triple To Quadruple Aim: Care Of The Patient Requires Care Of The Provider). In building their case, the authors cited the fact that 46% of U.S. physicians experience symptoms of burnout (defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment), and even those that don’t report burnout are feeling the strain. Sixty-eight percent of family physicians and 73% of general internists reported in a survey that they would not choose the same specialty if they could start their careers over. How does this threaten the achievement of the Triple-Aim? Thomas Bodenheimer, M.D. and Christine Sinsky, M.D., write:
Physician burnout is associated with reduced adherence to treatment plans, resulting in negatively affected clinical outcomes. Burnout also leads to lower levels of empathy, which is associated with worsened clinical outcomes for patients with diabetes. Patient safety is threatened by nurse dissatisfaction; many nurses report that their workload causes them to miss important changes in their patients’ condition. Dissatisfied physicians are 2 to 3 times more likely to leave practice, thereby exacerbating the growing shortage of primary care physicians and complicating the achievement of a healthy population.
The issue of clinical team engagement and satisfaction is not new. We’ve covered many elements of it before – What We Want From Our Leaders Is Different, 16% Of Physicians Hanging Up Their Spurs, and Burnout Is Big. But “connecting the dots” between clinical team engagement and performance under value-based reimbursement gives the issue a new level of strategic importance.
What does this mean for the organizations that serve consumers with the most complex support needs? We must create staff programs that support our clinicians who are providing care. Among the types of programs that should be incorporated into daily work life for clinicians are:
- Ensuring all team members are rewarded with challenging and meaningful work – Organizations need to create workflows that incorporate clinical team building, like assuring that staff are working to the top end of their licenses but are able to get assistance with work that can be done by a lower credentialed person.
- Ensuring that all staff feel part of a team and are able to get help when needed – Organizations should provide team meetings and supervision so that each staff member can avail themselves of guidance and support when working with high-needs persons.
- Assuring that staff understand that they are important to leadership and that they have a voice in their own work-life – Management can ask staff how they are doing and what they recommend to help themselves and others avoid burnout.
- Creating “bonded” teams – Staff bonding experiences provide an opportunity for everyone on the team to understand the mission and how their work contributes to that mission.
Too often in this hectic world of health and human services, executives and managers are grappling with “big picture” challenges – revenue streams, contracts, compliance, technology, and more. It is easy to lose sight of the fact that without our clinical staff, we could not meet the needs of the consumers that our organization serve. Just as we build person-centered, strengths-based plans for consumers of service, we should be striving to build those same supports for our clinical service deliverers. It comes down to assuring staff that they are important and valued.
For more coverage of this seminar, check out Finding & Developing Your Next Big Thing. For more on team building, check out these great sessions at The 2016 OPEN MINDS Executive Leadership Retreat – “How To Retain & Grow Employees: Turning The Millennial Generation Into The Leaders Of Tomorrow” led by author Misti Burmeister; and “Leaders Under Pressure: How Executives Can Manage Their Time & Avoid Burnout” by A. Robert Dunbar, MPA, M.Ed., Senior Associate, and Sarah C. Threnhauser, Executive Vice President, OPEN MINDS.