Before saying anything, I want to emphasize that CipherHealth is completely aligned with our provider partners in meeting the goals of the Triple Aim. Made famous in Don Berwick’s seminal 2008 article, the goals of improving population health, enhancing patient experience, and reducing per capita cost have been a focus of all of our provider relationships. But recently, we’ve seen some providers place emphasis on another priority–a fourth aim that we believe deserves elevation alongside the other three.

Recently Dr. Thomas Bodenheimer, a UCSF School of Medicine professor and Dr. Christine Sinsky of the American Medical Association authored an article which recommended “that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.” For health care organizations that ignore this fourth aim, the consequences can directly affect patient care. A 2011 Health Affairs article found both that dissatisfied nurses are associated with lower patient satisfaction and that important patient condition changes are missed due to workload.

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This message has resonated with stakeholders beyond the academic community. The American Nurses Association advertises reducing nurse burnout as a key benefit of its rigorous Magnet designation program in which over 400 hospitals have chosen to participate. In Media, Modern Healthcare has used voluntary staff turnover as a metric in evaluating provider organizations on its Best Places to Work list.

The question now is not whether staff happiness and retention are important–they obviously are–but whether these goals deserve to be prioritized alongside the aims of patient experience, population health, and cost reduction. One of our customers thinks so. One year ago, one system partnered with us to roll out a digital rounding solution in order to make life easier for nursing leaders across several facilities. Patient satisfaction scores–already high–weren’t the primary concern.

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In the process, we had to avoid some of the pitfalls that plague organizations trying to achieve triple aim goals. This organization’s targets had yielded dozens of initiatives, and thousands of hours of training. One method for training nurse leaders on our rounding solution got shot down quickly. “Whatever you do, don’t use an e-learning module,” the project leader advised us, in light of the proliferation of these instruments becoming a hallmark of initiative fatigue. Implementing a tool designed to make nursing life easier couldn’t begin with using a strategy that nurses saw as making life difficult.

Now, the same system has seen extraordinary results in the staff’s reported ability to deal with the pace of work, resolve issues effectively, and improve the hospital experience for both patients and their families (it’s also worthwhile to mention that HCAHPS scores improved). By making daily life for staff easier, other elements of the Triple Aim were easier to achieve.

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We would like to see the approach championed by Dr. Bodenheimer, Dr. Sinsky, and the system mentioned above adopted across the nation. The literature is sound and the results are compelling. We’re happy to share our approach with you, and if you’re interested in learning more about our results improving the staff experience and realizing the Quadruple Aim, click here.


CipherHealth empowers providers across the care continuum to deliver enhanced patient experiences and communications through a modular, comprehensive patient engagement technology platform.