In 2007, the Institute for Healthcare Improvement (IHI) introduced the Triple Aim framework to help improve the delivery of healthcare services across the industry, from doctor’s offices and acute care facilities to hospice and home health agencies.1 This framework focuses on the simultaneous pursuit of three goals: improving the patient experience, improving the health of populations, and reducing the cost per capita of healthcare.
While the Triple Aim was widely accepted by home health and hospice agencies as a way to enhance service delivery and patient satisfaction, a 2014 paper from Thomas Bodenheimer and Christine Sinsky found that increasing staff burnout “imperils the Triple Aim.”2 As a result, they suggested an update to the framework: The Quadruple Aim.
Hitting Healthcare Targets: Unpacking the Quadruple Aim
Concerns around healthcare staff burnout are well-founded: Recent survey data found that 55 percent of front-line healthcare workers reported mental and physical exhaustion from chronic workplace stress.3 As a result, the Department of Health and Human Services (HHS) projects a shortage of more than three million essential healthcare workers and 14,000 physicians by 2033.4
The Quadruple Aim looks to reduce staff burnout by identifying and mitigating stressors that negatively impact the experience of healthcare professionals. Common areas of concern include:
A 2021 study found that 51.6% of palliative care health providers experienced moderate compassion fatigue as they looked to help patients navigate end-of-life challenges.5 To help alleviate these issues, providers must consider ways to support staff — such as the implementation of mindfulness-based stress management solutions that include dedicated time for staff to relax and reconnect with their work each day.
Lack of Work/Life Balance
Home health and hospice staff may also struggle with work/life balance, in turn negatively impacting patient care and the patient experience. Consider that even as U.S. divorce rates hit a fifty-year low, the rate among licensed practical nurses (LPNs) reached 47 percent.6 Here, staffing is key — providers must be willing to pay what the market demands to ensure workers’ work/life balance, or they may find themselves on the wrong side of the Great Resignation.
Inefficient Data Entry
Technology issues around data entry and management remain a problem for healthcare and hospice staff. More than 32 percent of those asked said that they experienced frustration with technology at least 3-5 days per week, thus reducing their ability to effectively interact with patients.7 Addressing this issue requires solutions that simplify and streamline data entry while also providing on-demand access to patient records.
Persistent Pressure of COVID-19
While acute pandemic pressures are easing, problems remain: 97 percent of independent medical group practices say their ability to hit quadruple aim targets has been negatively impacted by COVID-19.8 In part, this stems from systemic changes to healthcare delivery — hospices must find ways to incorporate data-driven telehealth visits both to improve patient satisfaction and develop targeted care plans.
Hitting the Mark of Improved Staff Experience
When it comes to hitting the marks of the Quadruple Aim, there’s no quick fix. Single shots — however well-placed — aren’t enough to improve provider satisfaction over time and can reduce the efficacy of Triple Aim efforts. It’s critical for home health and hospice providers to stay the course by adopting best practices, such as dedicated time for mindfulness each day, written commitments to staff work/life balance, and the adoption of new technology solutions capable of streamlining data entry and underpinning telehealth efforts with enhanced reporting and documentation capabilities.
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Finding the Favorable: 5 Positive Impacts of COVID-19 for Hospice and Home Health Care
1 The Institute for Healthcare Improvement (IHI), “The IHI Triple Aim,” 2022.
2 PubMed.gov, “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider,” November 2014.
3 The Kaiser Family Foundation (KFF), “KFF/The Washington Post Frontline Health Care Workers Survey,” April 6, 2021.
4 The Department of Health and Human Services (HHS), “New Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation,” May 23, 2022.
5 BMC Palliative Care, “Compassion Fatigue and Compassion Satisfaction Among Palliative Care Health Providers: A Scoping Review,” June 23, 2021.
6 EduMed, “Achieving Work-Life Balance in Healthcare: An Online Guide for Students & Professionals,” August 19, 2020.
7 National Center for Biotechnology Information (NCBI), “Frustration With Technology and its Relation to Emotional Exhaustion Among Health Care Workers: Cross-sectional Observational Study,” July 6, 2021.
8 Mary Ann Liebert, Inc., “Impact of COVID-19 on the Quadruple Aim,” October 18, 2021.