From triple to quadruple aim: care of the patient requires care of the provider

Ann Fam Med. 2014 Nov-Dec;12(6):573-6. doi: 10.1370/afm.1713.


The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.

Keywords: health care workforce; patient-centered care; primary health care.

MeSH terms

  • Burnout, Professional / prevention & control*
  • Burnout, Professional / psychology
  • Cost Control
  • Health Care Costs
  • Humans
  • Job Satisfaction
  • Nurses / psychology
  • Patient Care Team / organization & administration
  • Patient Satisfaction
  • Personnel Turnover
  • Physicians / psychology*
  • Primary Health Care / organization & administration*
  • Professional Role
  • Quality of Health Care*
  • Quality of Life*