The healthcare system and its workforce are buckling under the weight of dramatic change, rising acuity, and pressure to reign in resources. To heal healthcare, we envision a Connected Healing Ecosystem of people, process, and technology that fosters respectful, empathetic interactions; builds trust; eases suffering; and restores the human connection to healthcare.
The US healthcare industry has been trying to transform ever since the Institute of Medicine published To Err is Human: Building a Safer Health System back in 2000. From there, Don Berwick, MD, MPP, FRCP, and the Institute for Healthcare Improvement coined the term, ‘the Triple Aim’ in 2008 to describe how the healthcare system needed to evolve toward improving care, health, and cost to arrive at a model that offered more equitable, compassionate, affordable, and error-free care.
Healthcare leaders doubled down on driving improvement, adopting Lean management systems, embracing high reliability, and building cultures of continuous improvement. They continue to do so while care team members work tirelessly to deliver care to patients with rising levels of acuity. And they are doing it in the face of increasing burdens of social determinants of health and the emergence of a serious economic downturn and rising opioid epidemic that strained the fabric of even the most compassionate care cultures.
By 2012, my colleague, mentor, and co-founder of the Experience Innovation Network, Bridget Duffy, MD, had expanded the notion of the Triple Aim to include the concept that a key ingredient of value-based care is to design systems that support the resilience, well-being, and even joy of care team members.
As burnout levels among doctors, nurses, extended care team members, and leaders rise, the Quadruple Aim reminds us that we cannot solve the challenges in healthcare without attending to how the work of healing is performed, and how care systems help team members achieve their highest healing potential.
In 2018, the National Taskforce for Humanity in Healthcare (NTH) published a position paper that outlines the business case for clinician well-being. The Taskforce, led by Bill Maples, MD, Ronald Paulus, MD, and Dr. Duffy, was formed with the goal changing the way leaders in healthcare view the responsibility of supporting care team members.
Rather than viewing burnout as an individual problem, we view it as the individual manifestation of a system problem. The solution to this system problem is not simply to provide individuals – or even teams – with tools that strengthen resilience and recover from the traumas of healthcare.
Instead, it’s a systemic model of leadership that maximizes team members’ access to positive emotions. Leaders need to build a culture of human connection and relationship-based support that minimizes trauma by including considerations of well-being and joy in every decision, whether about operations, clinical workflows, or new technologies.
The NTH is currently engaging a pioneer cohort of health systems to test the impact of this systemic model of leadership using a measurement model developed in partnership with J. Bryan Sexton, PhD. This measurement model will gauge thriving and recovery rather than the more deficit-focused burnout measures.
In the nearly two decades since To Err is Human, much has changed. There has been a lot of positive progress in striving for new levels of excellence, building in partnerships with patients and families, and recognizing that healthcare must keep humanity at its core. The Quadruple Aim has served us well in recognizing the multiplicity of aims that define health system success.
But, nevertheless, it’s time for a shift. Part of what has made the Quadruple Aim so devilishly difficult to achieve is that it allows us to hold these aims separately in our heads. There is patient experience, there is quality care, there is cost stewardship, and there is joy. The paradigm that defines the next 20 years of our efforts has to merge these concepts into one.
Last month, members of the Experience Innovation Network, the NTH, and other thought leaders convened in San Francisco to define the next generation of healthcare:
To heal healthcare we envision a Connected, Healing Ecosystem of people, process, and technology that fosters respectful, empathetic interactions, builds trust, eases suffering, and restores the human connection to healthcare.
The Connected Healing Ecosystem breaks down the silos of the Quadruple Aim and puts humanity squarely at the center of healthcare transformation. It is a unifying vision that recognizes that the forces shaping healthcare (advanced technology, redefined care models, evolving financing approaches, and even shifting regulations) must keep healing and humanity as their true north.
To accelerate realization of the Connected Healing Ecosystem, we launched three Councils that build on the past work of the Experience Innovation Network and the NTH:
Vocera and the Experience Innovation Network are excited to partner with dedicated leaders and patient-family partners who are committed to the vision of the Connected Healing Ecosystem, which is to usher in the next generation of care and caring.
We believe that we can restore humanity to healthcare and create a system that empowers care team members to achieve their highest healing potential, while giving patients and families to achieve their health goals. We hope you will join us on this journey!