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- Page navigation anchor for Re:Principles and dimensions of the fourth aimRe:Principles and dimensions of the fourth aimShow More
Dear Drs. Bodentheimer and Sinsky,
Though I appreciate the articles you've written and the comments I've read, I find it disturbing that there is little awareness that you are not in this cauldron by yourself.
I do not see that shifting medical charting to a nurse who is just as overburdened and just as burned out and suffering from compassion fatigue as you are a solution. Hospital management teams are...
Competing Interests: None declared. - Page navigation anchor for Re:Quadruple AimRe:Quadruple AimShow More
The authors have hit the nail on the head. It is vital to involve the passion of the health care workforce if Triple Aim is to be achieved. Here in the province of Saskatchewan, Canada - we initiated our transformational journey several years ago with our overarching aims being we call the "Four Betters" - Better Health, Better Care, Better Value and Better Teams. Read about our ongoing health care quality journey at:...
Competing Interests: None declared. - Page navigation anchor for Author response: The Group Health StoryAuthor response: The Group Health StoryShow More
The update from Dr. Mary Smith at Group Health Cooperative in Washington State is greatly appreciated. We are quite aware of problems at Group Health and at many other institutions. Burnout is like a forest fire; it keeps flaring up. We used the Group Health example to show that without attending to burnout, Triple Aim metrics do not improve and can indeed worsen, and that concern with burnout helps Triple Aim measures to...
Competing Interests: None declared. - Page navigation anchor for Re:Real Solutions neededRe:Real Solutions neededShow More
I completely agree with the comments posted. Until the expectations and workload are changed, there is no chance of improving burnout.
Just an update, as a family physician who works at Group Health which is mentioned as a success story in the article, our gains have now been reversed. The home model of longer patient visits and lower panel size was not sustainable, I assume financially, and the powers that be hav...
Competing Interests: None declared. - Page navigation anchor for Author response Re: Comment on From Triple to Quadruple Aim: Care of the Patient Requires Care of the ProviderAuthor response Re: Comment on From Triple to Quadruple Aim: Care of the Patient Requires Care of the ProviderShow More
Drs. Spinelli and Christensen eloquently described the problem of physician alienation from our beloved care of our patients. Thank you.
It is not surprising that their letter comes from one of the many high-performing health systems in Minnesota, unquestionably the leading place in the United States for primary care renewal. However, I worry that without confronting the mismatch of population demand for primary...
Competing Interests: None declared. - Page navigation anchor for Comment on From Triple to Quadruple Aim: Care of the Patient Requires Care of the ProviderComment on From Triple to Quadruple Aim: Care of the Patient Requires Care of the ProviderShow More
In their article From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider,(1) Drs. Bodenheimer and Sinsky highlight a silent but not unknown problem confronting healthcare redesign for improvement--the impact of rapid change and job expectations on the wellbeing of the physicians and staff who are implementing the changes.
For many years, Dr. W. Edwards Deming told us that a critical compon...
Competing Interests: None declared. - Page navigation anchor for Author response to letters to the editor Re: Quadruple AimAuthor response to letters to the editor Re: Quadruple AimShow More
We thank Drs. Epstein, Watkins and Antonucci for their thoughts. Each emphasizes the importance of professional satisfaction.
We empathize with the anger and frustration evident in the responses of Drs. Watkins and Antonucci, and believe that the solutions to professional burnout lie in action for both the short term and long term.
Practice re-engineering to eliminate unnecessary or misdirected work a...
Competing Interests: None declared. - Page navigation anchor for Author response Re: Real Solutions neededAuthor response Re: Real Solutions neededShow More
Dear Dr. Antonucci,
Thank you so much for your letter in response to the article "From Triple to Quadruple Aim (Ann Fam Med 2014;12:573-6)." You are so correct: the fundamental problem with primary care in the United States is serious underinvestment in primary care practices, including a major shortage of primary care clinicians which creates panel sizes that are too large for good care and a healthy worklife...
Competing Interests: None declared. - Page navigation anchor for Principles and dimensions of the fourth aimPrinciples and dimensions of the fourth aimShow More
While the disheartening statistics on the quality of clinicians' work life and its effects on burnout and quality of care are clear, I believe that there are some underlying principles that should be articulated in addition to the clear and prescient suggestions by Drs. Bodenheimer and Sinsky.
The first principle is that people work harder and more effectively when they feel engaged, that is, when work fulfills...
Competing Interests: None declared. - Page navigation anchor for Re: Real Solutions neededRe: Real Solutions neededShow More
I completely agree with Dr. Antonucci's comments.
This article could be described as at best, a group of workarounds; at worst, it is dangerously close to blaming the victim.
It contains nothing about fixing the fundamental flaws in the system, only a series of tricks to teach hamster-physicians how to run a little faster on the treadmill.
This is exactly what administrators and bureaucrats w...
Competing Interests: None declared. - Page navigation anchor for Real Solutions neededReal Solutions neededShow More
Oh my. The authors wonder if improving the work life of PCPs would help achieve the triple aim? May I gently, even humorously but with deadly serious intent, submit that we didn't need another article on burnout? What we need is a job that is desirable so that there are enough primary care physicians to do the work. What we need are very real solutions in several tough areas.
As a solo family doc with a high pe...
Competing Interests: None declared.