Using the Quadruple Aim as a Weapon to Eliminate Bullying & Burnout in Healthcare

Do you remember when medical care centered on the physician? When patients never questioned their treatment, couldn’t name the medications they were on (I take a pink pill in the morning, a blue pill at dinner…), and administration’s goal was to make the physicians happy; and when the nurses got up from their chairs to hand the physician the chart.

Then came the shift – the shift from physician centric to patient centric healthcare.

HCAHPS, patient satisfaction, and the patient experience became the primary focus. Hospitals reconstructed rooms from multi-patient to private rooms. Services like on demand for meals, beautifully decorated treatment rooms, and patient concierge became the norm. There was NOTHING more important to the executives than making sure their patients were happy.

Have you noticed that we’re shifting again?

Now, the focus is back on the physician but with a twist. It’s not just the physician. Now it’s the entire healthcare TEAM. Why? Because we’re burning out, disengaged, and behaving in ways that are unprofessional, disrespectful, and incredibly disruptive.

Did you know that…

• 33% of new nurses seek another job within a year 
In a 2015 study, 50% of physicians reported symptoms of burnout 
45% of nurses have been verbally harassed or bullied by other nurses and more than half indicated they were considering leaving the profession all together

We’re miserable and we’re taking it out on each other.

Hence why organizations, like the Institute for Healthcare Improvement (IHI) have added a fourth aim to their focus.

To refresh your memory…

The Triple Aim was designed to enhance the patient experience (1), improve population health (2), and reduce costs (3). The focus really centered on the patient experience beyond the acute care environment and sought to put the brakes on the escalating costs.

Recently, they’ve added a fourth aim, giving healthcare organizations the ability to choose a fourth area of focus. The recommendation is for that focus to be JOY AT WORK. Hence the new Quadruple Aim.

After all, you can’t focus on the patient experience and ignore the people who are 100% responsible for that experience – the healthcare team.

The health and wellbeing of the team was shown to play the biggest role in the actual patient experience. If the team feels good about the work they do, feel supported and valued by their colleagues, and believe that the work they do matters, patients receive better care, costs go down, and employees stay.

When the healthcare team experiences some level of joy at work, everyone wins.

Joy at Work as the Fourth Aim – 3 Steps

Choosing joy as the fourth aim is becoming popular for healthcare organizations. We’re finally recognizing that when employees feel good about the work they do, they deliver better care. When the administrative team puts as much attention on self-care, employee engagement, and professional behavior, they pave the way for employees to experience joy despite the ongoing challenges faced.

Give people permission to take care of themselves

Why is it that some people actually brag about not sleeping, never taking a break, or that they have a million hours of vacation time – unused, of course? Let’s stop being martyrs and start encouraging people to actually take care of themselves.

According to LeAnn Thieman, nurse, author, and self-care expert…

“Burnout, retention, low morale, poor engagement, and lack of resiliency are problems plaguing most healthcare organizations today. Employee wellbeing is crucial for ensuring both employee and patient satisfaction, increased safety, and organizational performance.”

To help healthcare employees, LeAnn developed a program called, SelfCare for HealthCare®, which provides a systemic change to restoring joy in the workplace and produces a cultural shift to improve the physical and fiscal health of organizations. 

Her program has been shown to raise clinician engagement and satisfaction results by 20-40% while reducing turnover, a major symptom of burnout and lack of joy in the workplace. Click here to learn more about LeAnn’s program.

Pay attention to employee engagement

You may think that employee turnover is the worst thing. However, there’s nothing worse than an employee who stays but becomes disengaged. We’ve all read the studies about the benefits of an engaged workforce yet how many organizations are actually doing something about it.

According to Vicki Hess…

“At the end of the day, improving and sustaining employee engagement is like most things. It takes doing the right things over time. One place to start is looking at what the organization can do strategically, what leaders can do tactically and what individuals can do personally. When all three groups work together, the results are amazing!”

Employee engagement expert, Vicki Hess, helps organizations hardwire engagement strategies at the executive, front line leader, and employee level.

Click here to download Vicki’s resource, 3 Secrets to Engaging Your Healthcare Team.

Stop ignoring disruptive behaviors

When disruptive behaviors go unaddressed in healthcare, bad things happen to patients and employees. Study after study shows the negative impact bullying and incivility have on employees (think retention) and patient outcomes. Yet many leaders ignore or justify someone’s bad behavior because they are so good at what they do.

It’s 2 o’clock in the morning. The nurse is concerned about her patient. However, when she looks at the schedule, the physician on-call is one notoriously known for screaming and yelling at nurses, making them feel like idiots. The nurse says, “I’m not calling him. He’s nasty.”

A newer nurse overhears this and in 6-months when she is in the same situation (and she will be), makes the same decision.

What if that patient, whom the nurse was concerned about, was your mom?

According to Dr. Renee Thompson (me)…

“The way healthcare employees treat each other SHOULD be just as important as the clinical care they provide.”

You can’t have joy at work if you’re ignoring your bullying problem.

Whether you’ve joined the other healthcare organizations by adding Joy at Work as your Quadruple Aim or not, spending the time, energy, and resources to help all members of the healthcare team feel good about the work they do and whom they do it with is not only a quadruple win for the organization, it’s the right thing to do for us all. We could all use a little more joy!


At the Healthy Workforce Institute, we’re on a mission to create a world where bullying and incivility are immediately rejected and kindness, respect, and professionalism become the new norm.
Click below to take a short quiz to find out how “healthy” your department is.

About Renee Thompson

Dr. Renee Thompson is a keynote speaker, author and professional development/anti-bullying thought leader. Renee spends the majority of her time helping healthcare and academic organizations address and eliminate bullying behavior. To find out how you can bring Renee to YOUR organization or nursing event, visit www.healthyworkforceinstitute.com

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