The Phantom Limb of the Triple Aim

Abstract

R ecent health care improvement efforts have focused on the Institute for Healthcare Improvement’s Triple Aim of improving patient care quality, decreasing total cost of care, and improving the experience of care for patients. The phantom limb of this triad is the well-being of the health care workforce that is essential for acting on and implementing the necessary changes for achieving the Triple Aim. Phantom limb pain is a condition in which patients experience a sensation of itching, twitching, or pain in a previously amputated limb or body part. The Triple Aim suffers from a similar phenomenon. Focusing only on the quality of patient care, the total cost of care, and the patient experience of care, the Triple Aim has separated the well-being of the health care workforce from system change initiatives. The separation has resulted in phantom limb pain, which is often expressed as burnout. In 2008, Berwick et al from the Institute for Healthcare Improvement proposed the Triple Aim as a model for improving health care in the United States. The Triple Aim defines a conversion from a “physician-centric” to a “patient-centric” medical system that is focused on “improving the experience of care, improving the health of populations, and reducing per capita costs of health care.” Since that time, many health care systems have embraced the goals of the Triple Aim. A conscious decision to measure and understand the patient experience of care coupled with the identification of measurable outcomes of quality is transforming the work we do. We see it in different ways, ranging from honoring patients as consumers who share in decision making to physicians who use evidence-based protocols for diagnosis and treatment. Arguments persist about whether these transformations will “bend the cost curve” for health care. Nonetheless, it seems clear that the Triple Aim will continue to be a part of medicine. Business models of employee engagement are widely used by health care systems to assess an individual’s attachment to an organization, but these models fail to account for the effects of an individual’s perception of his or