Society Newsletter

President’s Message

The “Forgotten Aim”- Provider Satisfaction and Well-Being
by Troy M. Falck, MD, FACEP, FAAEP, President, CMA Delegate

Since the introduction of the “Triple Aim” in 2008, the healthcare industry has been abuzz with talk of this multifaceted approach to achieving high-value care by reducing spending, improving population health and satisfying patients. However, one critical component of high-quality care has been omitted from this framework, the “Forgotten Aim” – the satisfaction and well-being of healthcare providers.  Drs. Thomas Bodenheimer and Christine Sinsky were perhaps the first to suggest the notion of the “Quadruple Aim” in terms of improving the work life of health care providers. (Bodenheimer T, Sinsky C, From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014 Nov-Dec;12(6):573-6.)

When medical providers are overburdened and disengaged, the provision of high-quality care can be compromised. Providers also feel increasingly overwhelmed by the amount of administrative related duties required of them. For instance, 43% of physicians surveyed in 2014 reported spending over 30% of their day on administrative tasks. In part due to this bureaucratic burden, burnout – defined as loss of enthusiasm, feelings of cynicism and a low sense of personal accomplishment – is prevalent among US physicians. According to the Medscape 2015 Physician Lifestyle Report, 50% of physicians reported experiencing burnout, with “too many bureaucratic tasks” and “spending too many hours at work” as the main factors. The dissatisfaction of providers can have negative effects on patient care.  Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Loss of empathy, alienation, addiction and drug abuse, depression, relationship problems, as well as physician suicide are all part of the spectrum that can occur when the needs of the provider are not given proper attention.

Several solutions to this burnout have been proposed, including providing clinicians with tools to improve workflow efficiency and reduce administrative burdens. Technology that improves care coordination and streamlines clinical workflow can have a considerable impact on care as providers are able to spend more time engaged with their patients.

Bodenheimer and Sinsky point to the Seattle-based Group Health Cooperative which in 2006 refocused its efforts and put the work life of clinicians at the top of their priority list.  The results were significant gains in clinical quality, patient experience, and cost reduction.

While doctors are inclined to always do what is necessary to take care of patients, an AMA-RAND report confirmed that the satisfaction physicians derive from their work is eroding as they spend more time on grueling administrative rules, regulations and paperwork than caring for patients. The report noted that many physicians say that the bureaucratic obstacles to providing patients with high-quality care are major contributors to symptoms of burnout, including emotional fatigue, depersonalization, loss of enthusiasm and early retirement.

Building on its prominent study with RAND Corporation earlier this year the American Medical Association (AMA) launched a new effort aimed at helping physicians redesign their medical practices to minimize stress and reignite professional fulfillment in their work.

AMA STEPS Forward is an interactive practice transformation series offering innovative strategies that will allow physicians and their staff to thrive in the evolving health care environment by working smarter, not harder. Physicians looking to refocus their practice can turn to AMA STEPS Forward for physician-developed strategies for confronting common challenges in busy medical practices and devoting more time to caring for patients.  The modules are free and you do not have to be an AMA membership to participate.

Physicians can access the collection of interactive, online educational modules to help address common practice challenges at, and also earn continuing medical education credit. There are 17 modules that include steps for implementation, case studies and downloadable videos, tools and resources. More than 25 modules are expected to be available by year’s end.

Current Modules include:

  • Conducting effective team meetings- Develop strategies and tactics for effective team meetings that strengthen working relationships and improve practice efficiency
  • Creating strong team culture- Evaluate and improve team culture in your practice.
  • Electronic health record implementation- Ease the transition from paper to electronic health records.
  • Electronic health record software selection and purchase- Understand practice needs and evaluate for electronic health record software selection and purchase
  • Expanded rooming and discharge protocols- Empower staff to take on additional responsibilities and make patient visits more meaningful and efficient
  • ICD-10 implementation- Prepare for the October 1 ICD-10 deadline
  • Improving Blood Pressure Control- Measure, Act, and Partner to help patients control blood pressure and ultimately prevent heart disease
  • Improving physician resiliency- Foster stress hardiness and protect against physician burnout.
  • Medication adherence- Improve the health of your patients and reduce overall health care costs.
  • Panel management- Focus on providing proactive, preventive care to improve the health of your patients.
  • Preventing physician burnout- Improve patient satisfaction, quality outcomes and provider recruitment and retention.
  • Preventing type 2 diabetes in at-risk patients- Help your patients find ways to prevent type 2 diabetes through education, screening and local referral programs.
  • Pre-visit laboratory testing- Save your practice time and effort while improving care and enhancing the patient experience.
  • Pre-visit planning- Enhance the patient’s experience, increase patient engagement, improve practice efficiency, and make providing care more enjoyable for the entire team.
  • Starting Lean health care- Eliminate waste in the workday and equip the team to spend more time on patient care.
  • Synchronizing prescription renewal- Save physician and staff time by renewing prescriptions until the next annual visit.
  • Team documentation- Spend more time interacting with your patients by enabling your staff to assist with team documentation.

The Triple Aim has provided a beacon pointing the way forward for the healthcare system in America. The “Forgotten Aim”- the positive satisfaction, well-being, and engagement of the healthcare workforce-  is of paramount importance in achieving these goals.  While there is so much work to do in this arena, there are tools available now like the AMA STEPS Forward Program, which promises one innovative way to assist physicians.

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The Placer Nevada County Medical Society's mission is to promote the science and art of medicine, the care and well being of patients, the protection of public health and the betterment of the medical profession.

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