The Fourth Aim

By | October 25, 2016

Value-based care must meet both consumer and provider needs

As we move to value-based care, we need to think differently around our “workforce.”  Consumers do not look at their need for care as a weekday, 9 to 5 service. They view their needs as 24/7, and thus want access in that same fashion. Illness does not take a break on weekends or at night. However, healthcare still views itself as more of a weekday service model. Weekends and holidays are lower staffed because services are reduced during these times. That includes physician coverage, which is much lower on weekends both in hospital and ambulatory settings.

A recent article in JAMA by Andrew F. Goddard, MD, Lessons to Be Learned from the UK Junior Doctors Strike, does a wonderful job describing what’s happening as the country grapples with improving weekend care. An underlying issue in my mind is the lack of common purpose of society at large and care providers in the United Kingdom. Each side views their needs differently, so the relationship has turned into a negotiation. There are lots of creative ways to handle “staffing” models, but in order for them to work, both those paying for the services and those providing the services have to agree on what  service is being delivered, and what it needs to look like from the consumer’s perspective.

How do we prevent the same thing from occurring here? We want our providers to have vocation satisfaction because without it, patient/person value will suffer. This fourth aim of provider satisfaction is paramount to the success of our healthcare system. We must focus on this polarity and solve for it. We must begin to set expectations and take the time to openly discuss common purposes and how to work together for a better situation. If we get to the point of a relationship based on negotiation, we have failed in delivering on the fourth aim and creating true value of those we serve.

We need to be taking the time now to better define what those needs are and create work force models that both fulfill the needs of those we serve and the needs of those we are asking to serve. We need to have these discussions at all levels, beginning during the education process and continuing beyond, never ending.. If we get to the point of one “side” dictating what the other “side” will do, we have failed.

Innovation requires us to learn from our past, learn from others, and be forward thinking in how we create a better healthcare environment for our providers and our population. We have made healthcare a societal priority and thus we must co-create models that lead to a greater common good.  Great minds will either create models that work, or lead us down paths that we do not wish to take.  Only through defining what our issues are, realizing that there is no singular answer, and being reverent to the process and individuals involved, will we succeed.