Home Health Care The Quadruple Aim: Focusing On Care Provider And Staff Well-being

The Quadruple Aim: Focusing On Care Provider And Staff Well-being

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A 2014 article in the Annals of Family Medicine, titled “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider” by Dr. Thomas Bodenheimer and Dr. Christine Sinsky, has become a clarion call to address the well-being needs of healthcare providers and staff.

The authors contend that the Triple Aim—to enhance the patient experience, improve population health, and reduce costs—will be attainable only when high rates of job burnout and dissatisfaction among care providers and staff are mitigated.

In the course of gathering data from focus groups, journey mapping, and walking interviews with more than 100 healthcare staff and clinicians, we have identified a number of guiding principles focused on improving the well-being and work life of care providers in a holistic way. Here is some of what we have learned about the well-being needs of healthcare providers and staff, and how these principles can be supported through design solutions.

Encourage and enable respite to restore energy, productivity, and sense of self
Sixteen percent of participants mentioned they don’t take breaks because of time, workload, and fear of being away from their patients. However, emotional exhaustion and job burnout are common problems among healthcare workers. Periodic respite breaks throughout the day are essential to restoring energy, productivity, and an overall sense of well-being. Respite spaces are most effective when dispersed near work areas throughout the facility, providing complete privacy from noise and other people. When possible, connect respite spaces to nature through a view or access to the outdoors.

Facilitate eating breaks for physical and social nourishment
Eating breaks are one of the most important activities to occur during work hours, serving as both nourishment for the body and social connection for the soul. However, the ability to take breaks for eating is highly dependent on staff workload, and these breaks are frequently skipped during busy times. Respondents pointed out several different eating locations and preferences on where to eat depended on workload, staffing, distance, and food options. Providing a variety of dining choices, such as small, dispersed eating spaces and outdoor spaces, as well as traditional cafeterias and break rooms, can help endorse eating breaks. Consider varied seating arrangements that accommodate different levels of social engagement, from privacy to socialization to collaboration, during break time.

Provide dedicated work zones for collaboration and concentration
Our database of past post-occupancy evaluations show that floor staff can spend 15 to 25 percent of their day collaborating with team members on patient care needs, and another 20 to 30 percent on focused, heads-down work such as charting. Dedicated space conducive to each type of activity is essential for efficient and quality care delivery. Collaboration requires ample space and privacy for colleagues to gather for discussions, while heads-down work involving concentration is best suited to quiet, protected work areas. Make available a variety of work zones in all departments and units—from private spaces for concentrated work to small group consulting rooms to large group collaboration areas.

Offer access to health-promoting amenities
Most healthcare professionals take great pride in their work, sometimes making their job a priority over other aspects of their lives, including personal health. Providing access to programs and spaces focused on well-being can reduce work-related burnout and stress. During focus groups and interviews, staff offered numerous suggestions regarding spaces and services that would improve their well-being and make their work lives easier, healthier, and more enjoyable, including on-site fitness centers (20 percent), dedicated lactation rooms (10 percent), garden areas (26 percent), on-site childcare (10 percent), and nearby food amenities such as café (33 percent).

Connect the indoors and outdoors
Healthcare providers, like all humans, have a strong innate desire to connect with nature as a means to mitigate stress. Outdoor areas are often viewed by respondents as places for respite (26 percent) and healing (21 percent). For some staff working in windowless spaces, there is a sense of being disconnected from what is happening in the outside world. Connecting the indoors and outdoors may include providing gardens, walking paths, or outdoor eating and respite spaces, as well as window views, natural lighting, or nature artwork.

Planning healthcare environments with these guiding principles in mind will do much to improve the well-being and work life of providers, bringing us closer to realizing the Quadruple Aim. After all, as Bodenheimer and Sinsky remind us, care of the patient requires care of the provider.

KaraFreihoefer, PhD, CID, EDAC, LEED ID+C is a design researcher at HGA (Milwaukee). She can be reached at kfreihoefer@hga.com.

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