The wide gap between societal expectations and professional reality has set the stage for 46% of US physicians to experience symptoms of burnout. In visiting primary care practices around the country, 2 the authors have repeatedly heard statements such as, “We have adopted the Triple Aim as our framework, but the stressful work life of our clinicians and staff impacts our ability to achieve the 3 aims.” These sentiments made us wonder, might there be a fourth aim-improving the work life of health care clinicians and staff-that, like the patient experience and cost reduction aims, must be achieved in order to succeed in improving population health? Should the Triple Aim become the Quadruple Aim?

1 The primary Triple Aim goal is to improve the health of the population, with 2 secondary goals-improving patient experience and reducing costs-contributing to the achievement of the primary goal. The Triple Aim is an approach to optimizing health system performance, proposing that health care institutions simultaneously pursue 3 dimensions of performance: improving the health of populations, enhancing the patient experience of care, and reducing the per capita cost of health care. Since Don Berwick and colleagues introduced the Triple Aim into the health care lexicon, this concept has spread to all corners of the health care system.

Doctors in training step 2 2014 pdf