‘Should healthcare care whether I’m happy or unhappy?’ Why the quadruple aim matters to cardiologists

In a medical landscape where nearly one-third of physicians are meeting criteria for burnout, healthcare’s newfound “quadruple aim” is struggling to find a foothold, former American College of Cardiology president Richard A. Chazal, MD, said at the college’s 67th annual symposium in Orlando.

Healthcare’s long-established “triple aim”—the idea that emphasizing better patient experiences, improving population health and reducing medical costs makes for a cohesive and successful practice—is losing steam, Chazal said. The field is in the process of making the transition to a four-pronged approach to better address physician burnout, but it isn’t easy.

He said burnout is not only linked to a lack of enthusiasm, cynicism and a low sense of accomplishment on the job. It also drives physicians to early retirement, fewer hours, alcohol use and even suicidal ideations. When healthcare is geared heavily toward patient satisfaction, clinicians’ quality of life can be pushed to the wayside.

“Should healthcare at large care about whether I’m happy or unhappy?” Chazal asked.

The short answer, he said, is yes.

A large-scale 2013 study by the RAND Corporation found that when physicians perceive themselves as providing high-quality care, they report better professional satisfaction. Obstacles to providing that grade of care—like clunky electronic healthcare record systems—were deemed “major sources of professional dissatisfaction.”

“Physicians approved of EHRs in concept, describing better ability to remotely access patient information and improvements in quality of care,” Chazal said. “For many physicians, the current state of EHR technology significantly worsened professional satisfaction in multiple ways.”

Poor usability, time-consuming data entry, inbox overload and lack of interoperability all contributed to this, he said. Those things, combined with the fact that EHR input is less professionally fulfilling work and interferes with face-to-face patient care, ends up outweighing any EHR positives.

And physician satisfaction matters, Chazal said. Studies have shown that less satisfied, burned-out and depressed physicians act less professionally, impacting not only the work environment but patient care.

“All of us have seen this in colleagues who have burned out and act in an irrational manner,” he said.

The Community Tracking Study Physician Survey, a series of nationally representative phone surveys of physicians first conducted in the late '90s, showed that very dissatisfied physicians were more likely to retire early or dramatically cut back on work hours—and losing a physician can cost a practice hundreds of thousands of dollars.

So, Chazal said, even putting aside clinician burnout, degradation of professionalism, reduced hours and early retirement, the healthcare world should care about the quadruple aim because it can have a significant, adverse effect on quality patient care.

He also said the ACC is working to include the fourth aim in its 2019-2024 strategic plan, which the college said is well underway.

“Working groups identified many common themes and developed narratives that painted a vision of the future,” officials wrote in a statement on the plan late last year. “Among the areas of focus for the future are optimization and support of team-based care as the primary driver of improved clinician wellbeing.”