From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider
Open accessAbstract
The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends 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.
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The Quadruple Aim Framework proposes that optimizing health system performance should involve simultaneously pursuing four interdependent objectives: population health, patient experience, provider experience, and per capita costs.
“This framework proposes that the optimization of the performance of the health system should involve simultaneously pursuing four interdependent objectives: population health, experience of receiving care (patients), experience of providing care (providers), and per capita costs.”
From A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide (2019) · cites this paper as [7]
The rise in attention to burnout in HCPs was solidified in 2014 when Bodenheimer and Sinsky established the Quadruple Aim, calling for improvement of HCP burnout and work life as essential for the functioning of the health-care system overall.
“The rise in attention to burnout in HCPs was solidified in 2014 when Bodenheimer and Sinsky established the Quadruple Aim, calling for improvement of HCP burnout and work life as essential for the functioning of the health-care system overall.10”
From Being Mindful: A Long-term Investigation of an Interdisciplinary Course in Mindfulness (2019) · cites this paper as [10]
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“The study is part of a broader program of research entitled EQUIP Health Care that aims to reduce health inequities at the point of care in pursuit of the quadruple aims of health system optimization: improving the health of populations, enhancing patient experiences and outcomes, reducing the per capita cost of care,…”
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- Authors
- Bodenheimer, T., & Sinsky, C.
- Affiliations
- University of California, San Francisco (US)
- American Medical Association (US)
- ORCID
- Sinsky, C.
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2014-11-01
- Volume
- 12
- Issue
- 6
- Pages
- 573-576
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC4226781
- OpenAlex
- W2161424516
- Semantic Scholar
- d9d04f53f5c5d6ba2a5034fed90c240c37e9204b
- Cited by
- 3,462
- References
- 35
- Citations by year
- 2026: 209 · 2025: 297 · 2024: 383 · 2023: 434 · 2022: 398 · 2021: 461 · 2020: 377 · 2019: 356 · 2018: 261 · 2017: 169 · 2016: 85 · 2015: 20 · 2014: 4 · 2013: 3 · 2012: 1
- FWCI
- 167.77
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- Quadruple Aim, Triple Aim, physician burnout, healthcare workforce, patient experience, population health, health care costs, work-life balance, clinician well-being, patient satisfaction
- MeSH terms
- Burnout, Professional, Cost Control, Humans, Job Satisfaction, Nurses, Patient Care Team, Personnel Turnover, Physicians, Primary Health Care, Quality of Health Care, Quality of Life, Health Care Costs, Patient Satisfaction, Professional Role
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