1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

Article Content

Maybe you read or heard about the article in the Annals of Family Medicine late last year recommending that the Triple Aim be expanded to the "Quadruple Aim." What, you ask? Another aim? We can barely manage three, never mind four. The suggested fourth aim-improving the work life of providers-struck a chord with me. How refreshing! The focus of the article was on primary care providers, although the message and suggestions are clearly applicable to our roles as nurse leaders.

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The authors, Bodenheimer and Sinsky, expressed concern that providers are challenged to improve health, patient experience, and costs (the Triple Aim) if workplace stressors aren't reduced. Right on! You can't have excellent outcomes without a healthy practice environment, which has been researched and supported in the nursing literature. So what does that mean for us?


It means we can't ease off our quest to improve the workplace. There are so many components to it, a variety of which have been written about in this journal and on this page. Important elements range from communication to collaboration to respect, and much more. Achieving a healthy workplace must remain a critical part of our vision, along with excellence in care; they go hand in hand. Wrapping it in a professional practice model that's actually lived and breathed every day is icing on the cake. Dare I say Magnet,(R) the gold standard?


Several suggestions mentioned for the primary care setting pertain to all patient care environments: team-based care, removing unnecessary work, and good training. If you're looking for a focus, this is a strong place to start. Imagine a workplace in which every member of the team works exquisitely together, everyone knows why and how to do his or her job, and all work effort is meaningful and useful. Triple Aim-no problem!


Of course those suggestions aren't easy. True collaboration isn't experienced without starting at the top and including every team member at the point of care, every day. Elimination of nonvalue-added work doesn't happen without staff involvement from beginning to end. An educated workforce doesn't result from uninteresting "mandatory" annual modules. Multiple other components may be addressed by leaders who are proponents of a healthy work life. We're on an unrelenting journey.


You can't affect organizational culture and processes single-handedly, but you can certainly drive unit culture, and even more depending on your scope of practice. That's what we do as leaders-set the tone and vision, involve everybody in the roadmap, share our successes and failures, learn from them, and never let up. Intertwined must be attention to the work environment at all levels and from all angles. If not, positive outcomes will probably be elusive.


There are plenty of roadblocks that often require delicate handling and calling in lifelines. Don't let that stop you; this is too important. It isn't separate work from bringing value-based care to our patients. It's all related and can't be accomplished through lip service or smoke and mirrors.


Our responsibility is to serve our staff, creating and promoting healthy practice environments. In this way, we'll get to the Triple Aim...and beyond.



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