The quadruple aim in the operating room

The well-being of healthcare providers and their staff is increasingly recognized as one of the cornerstones to securing better patient outcomes. Consequently, the Triple Aim, primarily concerned with improving patients’ lives, has been replaced with the Quadruple Aim, which also takes providers’ needs into account. But how do we approach the mission of achieving the Quadruple Aim for healthcare organizations to ultimately improve the well-being of care teams? And can we translate these goals to the operating room? We dive into these questions here. 

Optimizing the performance of healthcare systems has been a discussion point for decades. In 2007, the Institute for Healthcare Improvement (IHI) did, in fact, develop a framework, the Triple Aim, to support the goals of healthcare systems by focusing on three patient-centric areas (1):

  1. Improve patient experience 
  2. Improve population health 
  3. Reduce the per capita cost of care 

At its inception, the Triple Aim’s main focus was improving the lives of patients (2), but over time it became increasingly clear that this goal could be best achieved by also addressing the well-being of another key group – the care team.  

From the Triple Aim to the Quadruple Aim 

Over the past decade, healthcare organizations have begun to embrace a fourth aim: improving the work life of providers and their staff – the idea being that neglecting the provider experience can negatively impact the patient experience.  

This reasoning seems to be warranted. Data shows that lower staff engagement and burnout are linked with decreased patient satisfaction, worse health outcomes, and higher costs (3).  

Improving the work life of the care team has consequently gained wide adoption, turning the Triple Aim into the Quadruple Aim: 

  1. Improve patient experience 
  2. Improve population health 
  3. Reduce the per capita cost of care 
  4. Improve the well-being of the care team 

 Organizations are beginning to understand that a better patient experience starts with better provider engagement. In short, first-class healthcare is impossible without a physically and psychologically safe and healthy workforce (4). 

Well-being of care teams has become a primary concern 

Healthcare provider burnout is real. In a 2022 Medical Economics® survey, over 93% of physicians reported feeling burned out at some point in their career (5), and over 73% say they are currently experiencing burnout (6).   

Some of the ways physicians describe burnout are, “physical and emotional exhaustion; feelings of cynicism, negativity, and detachment from work; and inefficacy, feelings of incompetence, and lack of achievement and productivity (7).” 

Preventing and reducing burnout is essential for care team well-being, satisfaction, and retention, which in turn provides a better experience for patients. So how can we achieve this aim? Many organizations are finding that employing the right kind of digital healthcare technologies within their strategy can be a successful way to reduce burnout and improve care (8).

 Digital technology to achieve the Quadruple Aim  

 While the idea of the Quadruple Aim has been around for some time, healthcare organizations are now increasingly focusing their efforts on enhancing patient experience, improving population health, reducing costs, and improving the work-life of care teams.  

 Frost & Sullivan recently concluded a survey, finding that over 50% of hospitals are accelerating information technology (IT) investments to meet the Quadruple Aim.  

 Digital solutions can help save time and effort by streamlining work systems, reducing administrative burden, and ensuring best practices, all of which can improve conditions for physicians and their staff. 

As such, investing in digital solutions seems to be the answer for healthcare organizations to achieve two of their top priorities : improving customer experience and operational efficiencies. Alpa Shah, VP of CX Practice at Frost & Sullivan, explains, ”Healthcare companies can use robust data sets to develop new insights, which will help improve the quality and efficiency of healthcare (9).”

 Such comprehensive data sets are not only relevant to improving operational efficiencies at the organizational level but can also prove useful to specific departments and divisions, for instance, the operating room. 

The Quadruple Aim for the Operating Room 

 It is important to acknowledge that initiatives to achieve the Quadruple Aim and improve operational efficiencies will take time. The good news is that with the right tools and approach, organizations can accomplish their goals. 

Our team at DEO partners with hospitals to achieve the Quadruple Aim for the OR. Together, we work towards improving OR team ergonomics, process efficiency, financial performance, and patient experience. 

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 Ways to impact the Quadruple Aim in the OR 

 But what are some strategies for improving team ergonomics and consequently the experience of staff? What about OR process efficiency and financial performance?  

 In support of the Quadruple Aim, DEO collaborates with hospitals to:  

 Improve OR team ergonomics by… 

  • Reducing fatigue among medical staff 
  • Reducing high-risk poses 
  • Standardizing OR processes 
  • Reducing instrument trays and material complexity 

 Improve OR process efficiency by… 

  • Increasing surgeries per day with the same OR 
  • Increasing team capacity by optimizing flows 
  • Implementing OR efficiency best practices 
  • Implementing best-in-class technology 

Improve financial OR performance by… 

  • Reducing the total cost of surgery 
  • Impacting OPEX and CAPEX usage (e.g., removing process waste, reducing instrument trays, and better allocation of human resources) 

Improve patient experience by… 

  • Improving OR team well-being 
  • Improving process efficiency 
  • Increasing standardization & consistency 
  • Improving surgery outcomes 


 In the introduction, we posed the question: Can we apply the Quadruple Aim developed for healthcare organizations specifically to the operating room? The short answer is yes.  

The Quadruple Aim can serve as a compass to help guide change throughout all facets of the healthcare system. It provides a standardized framework that can be successfully translated to the OR to identify improvement opportunities that benefit all constituents – hospitals, patients, providers, and staff alike. 

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