Question special
Lead Moderator

A proposal to add "improving the work life of health care providers, including clinicians and staff," would make the "Triple Aim" the "Quadruple Aim" ( We are also paying more attention to physician wellness and the impact of burnout.

A key recommendation for achieving the fourth aim is to move away from a physician-centric model of workflow to a shared model among members of a team, with the goal of a "fundamental redesign of the medical encounter to restore the healing relationship of patients with their physicians and health care systems" (

Some features of the new delivery models can help to achieve this goal, but have been implemented poorly or hijacked to meet others' needs, as described in the book and in these discussions. If physicians are able to find their voice within their practices, much of that can be fixed. Other issues are more foundational:

How can practice models that better support work-life balance be compatible with a commitment to medical professionalism?

How do we reconcile the fourth aim with the Triple Aim's goal of improving the patient experience?