Competing Needs
Competing needs form an area of increasing concern for policy-makers across various industries. In fact, this issue is particularly topical for the healthcare context, as the number of stakeholders and other parties involved is highly considerable. Patients, medical managers, clinical teams, and authorities are engaged in a continuous process of improving the quality of care while enhancing the efficiency of the system. Under these circumstances, it is vital to balance the needs of all parties for the sustainable development of healthcare as an essential sphere of all developed communities. From one perspective, the system is expected to remain effective in that all resources and assets are to be utilized efficiently in terms of cost. Evidently, public and private entities allocate serious budgets to the development and provision of medical services, but this amount is not infinite by any means. At the same time, the quality of care in terms of patient experiences and outcomes is a matter of paramount importance that the system cannot afford to compromise. These two aspects of the sphere of healthcare often clash, forming two competing needs, and medical teams remain at their intersection.
On the one hand, the financial domain becomes an issue of increasing importance within the sphere of healthcare. In this context, the cost of treatment remains at the center of active discussions, along with the proposed ways of reducing them. Healthcare is an expensive sphere for all stakeholders and investors, and these matters have risen in terms of significance across recent years. In fact, as stated by Kelly and Porr (2018), contemporary institutions actively adopt a business-like model of medical service provision in contrast to the initial treat-heal-care design. Insurance companies, clinics, managers, and patients seek to optimize the financial aspect of care, and each side does so in its own interests. In a way, such an approach is justified by the prominent principles of economics. As essential as healthcare is for society, it cannot be fully excluded from the paradigm of economic relations. Accordingly, the inefficient distribution of budget leads to poorer levels of service coverage, thus contributing to the emergence and persistence of disparities in healthcare.
On the other hand, the need for budget optimization and profit gains often engages in a conflict with other aspects of care. In their pursuit of financial efficiency, contemporary institutions seek new ways of eliminating expenditures. In turn, this tendency often results in reduced staffing across various medical facilities. The numbers of physicians, nurses, and other clinical professionals are reduced in an attempt to lower the salary payment load on an organization. While this approach may contribute to the financial stability of an institution in the short term, the remaining members of medical teams become subject to excessive workload (Winter et al., 2020). In other words, modern organizations possess fewer specialists at their disposal, whereas the number of patients either increases or at least remains unchanged. In this situation, doctors and nurses experience a higher degree of work-related stress. Consequently, they endure fatigue, time shortage, and professional burnout, which prevents them from delivering adequate care. As a result, the quality of services decreases, thus impeding the need for the distinguished patient experience and outcomes.
Quadruple Aim
Nurses, physicians, and other medical professionals remain at the intersection of the competing needs discussed above. The constant drive for budget optimization combined with the increasing demand for high-quality, patient-centered care often creates an unfavorable work environment. Such a tendency is tightly related to the matter at hand, directly contributing to worker burnout and overall lack of engagement. In this regard, it is a pivotal objective of healthcare managers to develop and implement effective policies that will balance the needs of all parties involved. According to Fitzpatrick et al. (2019), the paradigm of Triple Aim has been a prominent approach to the organization of medical care delivery. The initial design of the policy comprises both patient and institution perspectives. For the former, the model states the pivotal status of improving the experience at medical facilities while promoting the health of the population in general. As for the organizations, Triple Aim equally acknowledges the importance of optimizing the costs of care. Therefore, the nature of the discussed policy directly reflects the aforementioned conflicting needs of healthcare.
Nevertheless, the initial design has undergone a natural evolution, acquiring the fourth dimension. The distinct aspect of Quadruple Aim recognizes the needs of medical team members and attracts the attention of the public on the matters of staff engagement and well-being. According to the policy, satisfied and motivated professionals serve as the primary enabler of medical care that is both cost-efficient and positive for the patient. In other words, Quadruple Aim, which is recognized by numerous American organizations, acknowledges the needs of medical professionals. Overall, this policy places the needs of the staff on the same hierarchy level as those of patients and organizations. As a result, unity appears, promoting the comprehensive development of the healthcare system in the country.
At the same time, the ethical aspect remains crucial for all spheres of human activity today. However, in the context of healthcare, these matters become especially important. As far as the Quadruple Aim policy is concerned, its principles appear to align with the ideas expressed by the American Nurses Association (2015). As per the ANA’s Code of Ethics, the clinical work environment is supposed to be comfortable and safe for the staff. Moreover, it is an ethical obligation of the healthcare organization management to create favorable conditions for all professionals engaged in the delivery of medical services. The ANA argues that all workers deserve to have their needs met by the management, thus improving the outcomes for all parties. Accordingly, the primary strength of the discussed policy is related to its comprehensive perspective on the provision of medical services. Quadruple Aim treats all elements of the system equally, which corresponds with the ideas of healthcare ethics.
Nevertheless, as is often the case, the policy in question still demonstrates some room for improvement. More specifically, its weaknesses are connected to the generalized discussion surrounding the fourth aspect of the Quadruple Aim. The rhetoric of the policy remains highly positive, as it prompts institutions to care about work conditions. At the same time, this paradigm does not appear to provide specific guidelines in regard to the expected improvements. As a result, a certain degree of indeterminacy arises, making the implementation of the policy vulnerable to subjective interpretations. This model will benefit from a concretized discussion embedded in it. For this purpose, it appears possible to assemble an interprofessional task force capable of the comprehensive analysis of the clinical work environment. Following these assessments, the expert group can devise and fix specific guidelines in terms of the optimal workload, resource distribution, patient communication, and general employment conditions. Ultimately, these recommendations will guide healthcare managers and employees toward a better future of accessible high-quality care.
References
American Nurses Association. (2015). Code of ethics for nurses: With interpretive statements. Web.
Fitzpatrick, B., Bloore, K., & Blake, N. (2019). Joy in work and reducing nurse burnout: From Triple Aim to Quadruple Aim. AACN: Advanced Critical Care, 30(2), 185–188.
Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: The Online Journal of Issues in Nursing, 23(1).
Winter, V., Schreyögg, J., & Thiel, A. (2020). Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction. Health Policy, 124(4), 380–388. Web.