Burnout Calls for a Quadruple Aim

By AJ Stephens, DNP, MBA/HCA, RN-BC, CMSRN, NEA-BC, Treasurer, Texas Organization of Nurse Executives 

The Triple Aim, a compass leading to the maximum optimization of health care, is now a widely accepted model for health care organizations to enrich the patient experience, improve the health of entire populations and reduce per capita cost of providing care. Society is placing increased demands on the health care system and clinicians, and staff are feeling the pressure. A widening gap between patient expectations and the realities of providing care is leading to career burnout in physicians, nurses and staff. Burnout in the health care workforce jeopardizes the objectives of the Triple Aim and, ultimately, the quality and cost of care provided to patients.

The imbalance between societal expectations and truths in the practice setting are leading to burnout at remarkable rates. Up to 46% of physicians in the United States experience symptoms of burnout, with exceptional prevalence in emergency departments, general internists, neurologists and family practice providers (Bodenheimer & Sinsky, 2014). Unhappy physicians are more likely to leave their practice area, and turnover costs are as high as $250,000 per physician replacement (Bodenheimer & Sinsky, 2014).

Nursing burnout and work-related stress provide just as much threat to achieving the Triple Aim and the need for nurses is on the rise. There are approximately 3.6 million registered nurses in the U.S., and 44.7% of those are age 50 or older and approaching retirement age (Welding, 2011). Thirty-four percent of acute care nurses, 37% of long-term care nurses and 22% of nurses in other practice settings report symptoms of burnout (Bodenheimer & Sinsky, 2014). Following the implementation of the Affordable Care Act in 2010, 32 million more Americans have access to care, pushing the nursing shortage to one million vacant positions by 2018 (Welding, 2011). All-inclusive costs for nursing turnover now suggest $115,000 per registered nurse replacement (Welding, 2011).

In today’s health care environment, a Quadruple Aim must be realized which incorporates the need for a happy and healthy workforce. Focus on reversing a dispirited and disengaged workforce is imperative on the journey to the Triple Aim (Bodenheimer & Sinsky, 2014). High costs of turnover threaten the control of health care expenditures, and high burnout and vacancy rates pose great risks to care quality and patient experience. Health care leaders would behoove themselves to identify stressors for physicians, nurses and other staff which can lead to burnout. A balanced relationship between those who seek care and those who provide is essential to success.

References

Bodenheimer, T. & Sinksy, C. (2014). From triple to quadruple aim: care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573-576. doi:10.1370/afm.1713

Kooker, B., & Kamikawa, C. (2011). Successful strategies to improve RN retention and patient outcomes in a large medical center in Hawaii. Journal of Clinical Nursing, 20(1/2), 34-39. doi:10.1111/j.1365-2702.2010.03476.x

Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and Increase Clinical Competence. MEDSURG Nursing, 20(1), 37-40.