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Since the introduction of the Triple Aim by the Institute for Healthcare Improvement (IHI) more than15 years ago, efforts to improve the US health care system have been guided by the goals of enhancing patients’ experience of care, improving population health, and reducing per capita health care spending. In 2022, it was proposed that the Triple Aim framework expand to include two critically important goals: workforce well-being and safety and advancement of health equity. In explaining the rationale for proposing this Quintuple Aim, the IHI’s president and CEO stated that the Triple Aim would not be achievable without attention to these additional imperatives. In this article, we focus on one of the key components of the fourth aim: workforce well-being.
Despite widespread recognition of the need to improve clinician work life, it has been largely overlooked in the value-based payment models being used in the US today. Value-based payment models are designed to financially incentivize health care organizations to provide better patient care and reduce costs, thus aligning organizational behaviors and health care markets with patient benefit and value. With more than 4.6 million US nurses providing the majority of hands-on direct patient care across care settings, addressing the well-being of this largest health care profession is critical for achieving the fourth goal of the Quintuple Aim. But for decades, the nursing workforce has been plagued with job dissatisfaction, burnout, and high turnover. More than half of US registered nurses are employed by hospitals, the practice setting associated with the highest nurse burnout rates.