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The Quadruple Aim

July 25, 2017

Most people in healthcare have heard of the Triple Aim—a framework developed by the Institute for Healthcare Improvement for optimizing health systems by simultaneously pursuing three dimensions:

  • Improved patient experience
  • Better outcomes
  • Lower costs of care

But what about the Quadruple Aim?

I recently attended the AMDIS Physician-Computer Connection Symposium, and a talk by Dr. Howard Landa about the fourth pillar of the Quadruple Aim triggered some thoughts on how communications play a role in physician satisfaction.

The Quadruple Aim adds the “improved clinician experience.” In a recent survey by The Physicians Foundation, 54 percent of physicians said their morale is somewhat or very negative. During the AMDIS Symposium, Dr. Landa spoke about how the EHR is frequently mentioned as an important cause of lower satisfaction and physician burnout.

In my discussions with practicing physicians and physician leaders at organizations across the country, another common frustration that can contribute to poor morale is ineffective care team communications. I had the opportunity to lead a focus group on this topic at AMDIS, and one participant commented that while there are amazing emerging technologies in areas such as genomics and predictive medicine, providers still can’t figure out how to find and get in touch with the other physicians taking care of a patient.

Another commented that it is not uncommon for a radiologist to spend 10-15 minutes trying to track down a physician for a critical result. The sheer multitude of small frustrations and inefficiencies in many health system communication processes add up to a large opportunity to recover lost time for physicians, and to create an easier way for physicians to collaborate with the care team and their colleagues.

Based on my discussions, I’d like to share five questions healthcare leaders should ask themselves about provider communications at their organization:

1. Do you have a source of truth for how to contact physicians? And is that source available to everybody who needs it?

For many organizations, all attempts to track down providers have to go through an answering service, an operator, or the office. Some physicians are fine sharing phone numbers with their colleagues today, but that is not a good solution. With Spok, we can directly send the messages via an online, secure directory and messaging system, thus eliminating the need to “track” anything down.

2. Have you hardwired communications in a manner that providers receive rich, detailed, actionable information?

Which message is more frustrating to a provider?:



Janet Smith RM 3201 5/2/1927 has a potassium of 3.0. Margaret Jones, RN x4-5212.

Simply putting a policy and a standardized template in place for messaging can allow providers to make decisions about priorities and actions, and eliminate many unnecessary phone calls.

3. Have you eliminated non value-added communications?

Through an enterprise healthcare communications platform, organizations can perform periodic reviews and analytics to determine inappropriate, redundant, and/or unnecessary messages that add no value to the patient care process. One organization that I worked with eliminated a large percentage of unnecessary messages to providers by analyzing communication patterns and message content, implementing structured communication templates, and reinforcing proper use of communication tools.

4. Can providers find the right on-call provider quickly?

With ever-shifting call schedules, is there a unified, simple way for all providers to know exactly who to contact, and then be able to quickly communicate with that person? A unified call schedule as part of your communication structure creates a single source of truth, so care team members know  who and how to contact for any given group or specialty.

5. Is it easy to respond to messages or requests to close the communication loop?

Many communication loops can be closed by a simple response to a message, eliminating unnecessary phone calls and the uncertainty that a message may not have been received and viewed. Secure message solutions allow for an ongoing, asynchronous dialog that eliminates the frustration of phone tag and hold music when a phone call is not necessary.
Communications are often an undervalued component of ongoing wasted time and frustration for physicians. Addressing the clinician experience challenges of the Quadruple Aim will take a thoughtful, broad set of improvements, and communication workflow and technology improvements can make a meaningful difference. By eliminating many daily annoyances and streamlining communications, you are ultimately giving physicians precious time back in their day.


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Provider Experience

By Dr. Andrew Mellin, Chief Medical Officer
Dr. Mellin has almost 20 years of experience as both a practicing physician and healthcare executive. He brings an extensive background in health information technology including leading physician adoption programs for new technologies and developing innovative clinical solutions. Previous to joining Spok he was VP, Medical Director at RedBrick Health, where he helped health systems drive employee engagement of consumer-oriented population health and well-being solutions. Prior to RedBrick Health, Dr. Mellin spent 15 years at McKesson in various positions where he served as Medical Director for McKesson’s population health analytics solutions, developed a novel real-time quality solution for hospitals, and led physician strategy and product management for the electronic health record. He previously served as Medical Director for Allina Health’s Davies Award-winning implementation of an electronic health record at nine hospitals and 60 clinics across Minnesota. Dr. Mellin received his M.D. from Duke University in Durham, N.C., and his MBA from the University of Minnesota, Carlson School of Management. He trained in Internal Medicine at Barnes Hospital in St. Louis, Mo., and is board certified in Internal Medicine.