How the Quadruple Aim May be at Odds with the Triple Aim

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 17. Healthcare Providers & Practice I

Abstract

In 2008, in response to skyrocketing healthcare costs and poor health outcomes in the U.S., the Institute for Healthcare Improvement introduced a three-pronged approach to optimizing health systems—the so-called “Triple Aim”: 1) improving population health, by 2) ameliorating the patient experience, and 3) reducing costs. (While not a governmental policy per se, the goals of the Triple Aim to shift from “volume to value” were at the heart of the reforms implemented by the Affordable Care Act).

As healthcare organizations widely began implementing the Triple Aim, however, an important pre-condition became increasingly evident: protecting health professionals' work lives. Physician dissatisfaction and burnout are known contributors to worse patient health outcomes and increased costs; conversely, pursuing the Triple Aim without regard for professional wellbeing can worsen physician burnout and dissatisfaction. Scholars therefore called for adding one more aim to the original three: restoring meaning and joy in professionals’ work by providing safe work environments in which they feel heard and valued. The now-Quadruple Aim is a widely-recognized model for delivering high-value healthcare and optimizing healthcare system performance across the country.

Yet, despite its introduction over ten years ago, the Quadruple Aim’s implementation remains uneven and challenging. One potential reason could be that the aims fundamentally conflict with one another. To what extent might organizational efforts to "rationalize" (i.e. reduce costs, increase access, and improve healthcare quality - the original Triple Aim) create work conditions that are, in fact, “irrational” by undermining physician wellbeing and engagement? This study leverages ethnographic and survey data collected between 2020-2022 from three outpatient clinics in pediatrics and surgery to examine how the original Triple Aim is shaping medical work in ways that leave physicians and trainees feeling undervalued and disengaged, thereby undermining all four tenets of the Quadruple Aim.

Author

• Tania M. Jenkins, University of North Carolina-Chapel Hill