Background: In recent years, in large part due to reimbursement incentives, the healthcare industry has shifted focus from volume to quality of care, with patient satisfaction being a crucial part of the evaluation. There is growing recognition that patient satisfaction is at least in part linked to clinician satisfaction and burnout(1). Thus, there is a call for healthcare systems to focus on meeting the quadruple aim(2), bringing provider satisfaction into the equation as as key contributor to providing high quality care. 1. Dewa CS, et al. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open. 2017,7(6).
2. Bodenheimer T, et al. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. 2014,12:573-576.
Purpose: To meet the quadruple aim, healthcare organizations need to evaluate their health tech platforms in order to optimize quality of care, meet regulatory requirements, support clinical workflows and also to improve clinician workflow and experience. Although evidence shows that paper lists are outdated within ~3.5 hours(3), the lack of usable mobile tools to view clinical data leads clinicians to print data to reference and make decisions from throughout the day. This accessibility issue coupled with information overload from having to find and interpret data siloed on multiple different screens and sections only further exacerbates physician burnout and hinders high quality care.
3. Rosenbluth G, Jacolbia R, Milev D, Auerbach AD. Half-life of a printed handoff document. BMJ Qual Saf 2015;0:1–5.
Description: To meet the needs of clinicians and provide a tool that integrates seamlessly into clinical workflows, our institution created an EHR connected web app that gives clinicians access to the data they need, when they need it, and a platform to plan, track and manage the care of their patients. Focusing on collaboration, we created a dynamic, team based interface, including interactive, semi-structured patient centered task lists to enable better handoffs and care team planning and communication.
Nine months after implementation (Oct. 2016), our application had ~3,500 unique weekly users, with over 100K patient views, and approximately 1.25 million actions performed weekly. Unlike many other homegrown applications, our tool has been widely adopted on all main inpatient services at our four main hospitals (>130 services) and is the health system’s official, standardized tool for handoffs. Our tool is interdisciplinary with 50% of the users being nurses and another ~15% therapists, social workers, pharmacists and more.. A recent survey of ~230 users showed that 80% believe the app helps make them more efficient, and 75% believe it has prevented errors.
Conclusions: To truly improve the quality of care we are able to provide, we must strive to reach the Quadruple Aim. This will require organizations to invest in and utilize tools that are designed specifically to meet the needs of front-line clinicians – not just those of the administrations bottom line. Through our work, we have begun to show exactly that: well designed health technology can in fact improve the front-line clinician’s experience and workflow and ultimately improve patient care. Further research is needed in the applied informatics arena to better understand and define the added benefit of clinician centered, EHR connected tools such as ours and their effect on clinical outcomes, clinician experience and patient satisfaction.
To cite this abstract:Airan-Javia, SL; Soegaard Ballester, J; Bass, G; Joshi, P. REACHING THE QUADRUPLE AIM THROUGH USER-CENTERED TECHNOLOGY DESIGNED TO OPTIMIZE CARE DELIVERY AND CLINICIAN WORKFLOW. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 381. https://www.shmabstracts.com/abstract/reaching-the-quadruple-aim-through-user-centered-technology-designed-to-optimize-care-delivery-and-clinician-workflow/. Accessed January 21, 2020.