Triple Aim Needs a Fourth Target: Clinician Experience

 In Home Health, Hospice, Industry Voices, News

A Missing Target?

The Triple Aim is the driving factor behind many initiatives in healthcare today, touching providers in acute care, post-acute, and even pre-acute care. Many government, payer, and even provider initiatives are guided by the Triple Aim in an effort to improve healthcare systems for all stakeholders. While many issues that impact healthcare today are indeed addressed by the Triple Aim, it does not go far enough. Again, healthcare is behind the times and needs to take a queue from other industries and pay more attention to those on the front line actually providing the care.

We’ve all heard of the Triple Aim of healthcare. Created by the IHI (Institute for Healthcare Improvement), it is simply a guide to optimize healthcare systems. With aging populations and chronic health problems, increased longevity puts new demands on medical and social services. The Triple Aim addresses the key drivers that would improve the current systems.

The Triple Aim is designed to simultaneously pursue three dimensions:

  1. Improve care
    Clinical satisfaction

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  2. Reduce costs
  3. Enhance the patient experience

These three dimensions are indeed worthwhile targets. However, there is one critical component missing from the Triple Aim: enhancing the clinicians’ experience. Put another way- Clinical satisfaction.

The Missing Link to Healthcare Improvement

In the ever-changing world of healthcare, home health agencies have become accustomed to evolving their business models; Not only to remain compliant, but to improve care and reduce costs. It’s time to continue the evolution and aim for happier caregivers. Focusing on a boost in clinician job satisfaction not only benefits the clinician, but the agency and patients in their care. The business world has long recognized that employees are the key to customer satisfaction, and if home health agencies can adopt this mentality, better care will come naturally.

One of the pioneers of this concept, Herb Keller of Southwest Airlines, set an unprecedented example when he proclaimed that the people in an organization are more important than the customers. If your people are happy, they are much more likely to make your customers happy, he argued. It was a novel concept at the time, but now Keller’s method of management is now widely adopted at top companies, but not often in healthcare.

The nursing force in every healthcare institution defines the success of the company, and is the “face” of the agency or institution in the eyes of the patient. In a home care setting, the nurse (or aide) on the front-line might be the only person with whom the patient interacts. As agencies strive to achieve the Triple Aim through value-based purchasing (VBP), you could argue that nurses are more responsible for the patient-satisfaction component than ever before. If home health agencies can reconsider the value of their clinicians, and put strategies in place to increase job satisfaction and retention, better care will naturally occur.

Strategies for Increasing Satisfaction With Your Clinical Staff

There is not a one size fits all solution for increasing clinician satisfaction. However, there are standards that can be customized to fit the unique business model and culture of any home health agency. Below are some strategies to consider (Adapted from a presentation delivered at the National Association for Home Care & Hospice’s 2016 Annual Meeting by Sharon Brothers of Institute for Professional Care Education):

  1. Know and track your retention – What is the industry average, how does your agency compare, and what goals can you set to improve retention rates?
  2. Provide training for all employees – Generally speaking, 25 percent of all employees leave their jobs mainly due to lack of training and learning opportunities. On the other hand, companies who provide learning opportunities generate about 26 percent more revenue per employee.
  3. Provide training for leaders in the business – Oftentimes, people don’t leave an organization because it’s a bad company, they leave bad management.
  4. Hire better – Create a more in-depth screening and interview process so the best candidate for each position may be selected.
  5. Provide a pathway for growth – Employees want to know they have the potential to grow within an organization. Create clear paths for growth for each position, outlining the key milestones and goals that must be achieved at each level.
  6. Engage – It’s important to engage on a personal and professional level; showing interest in an employee’s personal life makes them feel like they matter beyond what their daily role is in the organization. Professionally, take the time to collect feedback and listen to ideas.
  7. Increase flexibility – This is a huge factor in today’s mobile-friendly work environment; consider what options you might have to offer your employees, like having more control over their schedules.
  8. Help relieve stress – Provide education on stress management and create a culture that supports laughter and friendships among employees.
  9. Reevaluate your benefits – Today’s job seekers aren’t solely focused on the almighty dollar. Things like a flexible work schedule may outweigh the need for a higher salary.
  10. Equip staff with technology – Home health technology has come a long way, and choosing to adopt easy to use technology can do wonders for increasing clinician satisfaction. Allowing clinicians to complete documentation at the point-of-care while with a patient, or shortly after, alleviates the necessity for completing documentation during their personal time. Remember this rule of thumb: if the technology doesn’t simplify the job, the job may not get done (Marino, D.)

Better for Business. That Means Healthcare Too.

Yes, it’s true that targeting clinical satisfaction will position your agency for Value-Based Purchasing. However, high clinical satisfaction will reduce turnover, driving costs lower. With less resources dedicated to hiring new clinicians, your on-boarding costs go lower and your average experience level goes up. Lower costs and higher experience levels are a win-win.

The gap that is left is actual measurement of satisfaction. I’d suggest that it become an initiative for your agency in 2017. It begins by measuring a baseline of current satisfaction and then creating targets. I’d suggest a simple tool like Survey Monkey to survey your employees. If you want to be more elaborate and automated, a tool like MoodMap might be the best choice. If you survey your entire agency, just make sure you create a way to measure clinicians separately. You might consider segmenting your clinicians further, as the factors affecting nurses is likely different than your therapists and aides.

The creator of the Triple Aim, IHI, believes everyone should get the best care and achieve the best health possible. If we as providers add “Clinician Satisfaction” as a Fourth Target of the Triple Aim, we will have a model that can drive healthcare into the future that will meet the IHI vision.

A version of this article originally appeared in the Home Care Tech Report dated 1/16/2017.

Follow up

The inspiration for this concept came from clients in the home health care industry. In a meeting with a particular client, we took a break and the conversation turned toward provider philosophy and how it impacts the mission of a home healthcare organization. When discussing the core values and pillars of their company when I asked why they selected our web-based software solution and why it’s an integral part of their growth plans. Their answer: “We value the clinical experience, and we believe clinical satisfaction is an important driver to improving healthcare.”  They continued “The pursuit of clinician satisfaction is one of our core values. It should be the fourth target of the Triple Aim.” Upon further research, there is a movement in healthcare to adopt this standard, many referring to it as the Quadruple Aim of healthcare. If you’re a believer, then you should share the word as well!

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