Achieving the Quadruple Aim

December 5, 2017

Focus on Higher Clinician Satisfaction

By Joseph Frolkis MD, PhD, FACP, FAHA

President and Chief Executive Officer, New England Quality Care Alliance


Joe Frolkis  During her last meeting as NEQCA Board Chair, Michele Crage, MD emphatically told her fellow Trustees, "Nobody gets the Quadruple Aim like NEQCA!" I think she's right. While we didn't invent it, we've embraced the model, first introduced by Thomas Bodenheimer, MD and Christine Sinsky, MD in 2014, earlier and more fully than many other networks, and we've made it a central part of everything we do. I also believe it will continue to be a differentiator for our network, and our affiliated practices, as we work together on goals of better care, better health, lower cost and higher clinician satisfaction. Periodically, I'll write a short piece on one of the aims, and I decided to start this series with the one that often appears last on the list. The Fourth Aim is about improving the work life of those who deliver care, and we’ve made it – as I hope you realize – a major priority at NEQCA.

  • Over the past several months, Chief Medical Officer Jatin Dave has assembled a workgroup of NEQCA physicians to measure and improve physician wellbeing. As a first step, the group is working to identify and implement organizational strategies for a healthier work environment to improve physician wellness.  At the same time, they are looking at tactics to improve self-care in order to build resilience and protect against burnout. The longer-term goal is to create a sustainable model and a plan with clear deliverables and to focus on one or two initiatives each year. In 2018, the group will consider templates to reduce the time burden of documentation and some form of ‘social networking’ to reduce the clinical isolation of solo practice.
  • This summer, we hosted a NEQCA Connection program with Steve Beeson, Founder of The Clinician Experience Project, and the feedback we received on the program was terrific. 95% of survey respondents said the program helped them understand what can be done individually and as a team to combat physician burnout and improve the clinician experience.
  • At our recent NEQCA Annual Forum, we dedicated one of three breakout sessions to the important topic of physician resiliency. In that session, Gail Gazelle, MD shared fifteen practical strategies to improve self-care and reduce burnout. More than 175 NEQCA clinicians and staff members registered for that session.
  • In addition to our efforts within the NEQCA network, we’re also committed to advocating with key stakeholders and policy makers to reduce administrative burdens. I recently nominated Dr. Dave to serve on the joint Massachusetts Hospital Association – Massachusetts Medical Society Physician Burnout Task Force, which will begin its work in January 2018.

While we’re pleased with these initial efforts, we know that we’re far from being able to declare victory just yet. It is not enough to recognize and acknowledge the factors that contribute to physician burnout. We are holding ourselves to the higher (and harder) goal of defining specific and concrete interventions we can make that will have an equally concrete impact on the administrative burdens our providers face that are so toxic to our professional wellbeing. Unless and until we achieve the Fourth Aim, it will be difficult at best to make progress on the other three. As one of many physician leaders in our network, rest assured that I get it. And, I'll end by concurring with Michele's assessment that at NEQCA, we get it more than most!

Read more about the origins of The Quadruple Aim.