Chronic Disease, Mental Health, Provider Communication Skills, Substance Use 03.19.2019

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Meeting the Quadruple Aim with Simulation Technology

When it comes to improving the U.S. health system, many look to the “gold standard” model of enhancing patient experience: the Triple Aim. But what about providers? The Quadruple Aim takes into account this important prerequisite to improving population health.

Quadruple Aim

From Triple Aim to Quadruple Aim

Introduced in 2008 by the Institute for Healthcare Improvement, the Triple Aim is a patient-focused model meant to optimize performance of hospitals and health systems that want to lower costs and improve patient care. The three components of the Triple Aim are:

  • Improving population health
  • Enhancing the patient experience through better care
  • Reducing per capita cost through improving value

In 2010, the Triple Aim became integrated into the Affordable Care Act. It became widely used as healthcare reform provided financial incentive for value-based care.

In 2014, an article published in the Annals of Family Medicine noticed an area overlooked in the Triple Aim. According to the authors, physician burnout was an issue that the healthcare system needed to address. Forty-six percent of U.S. physicians reported symptoms of burnout, leading to “lower patient satisfaction, reduced health outcomes, and [the potential of increased] costs.”

They argued that addressing the well-being of healthcare providers was a necessary prerequisite for achieving the Triple Aim. Therefore, the addition of provider satisfaction to the Triple Aim model has become known as the Quadruple Aim.

Achieving All Four Aims

The road to improving population health is not easy. With no perfect solution for achieving the objectives of the Quadruple Aim in the healthcare system, the model still serves as a guideline for organizations. At Kognito, we see a big opportunity in implementing training experiences for providers that address the Quadruple Aim objectives.

Improving work life for healthcare providers

Work life has declined for providers in recent years due to reasons such as increased stress from more paperwork and administrative tasks and feelings of not providing quality care to patients. Health professionals must also dedicate time every few years to continuing medical education. In some states, these obligations involve mandatory trainings and up to 100 CME hours.

Quadruple Aim Provider Satisfactino
Data from over 75,000 healthcare providers

Continuing medical education can be streamlined through technology. But new technology in the healthcare space can be met with skepticism, since it can sometimes contribute to burnout rather than ease clinician burden. If done the right way, improving provider satisfaction involves engaging with them differently with the power of technology. A training solution for healthcare providers should be mindful of their time and supply them with a delightful, effective learning experience.

For new health professionals or students, training through technology can also help shrink the gap between building a knowledge base and applying that knowledge base in practice. Burnout can happen early in professional careers in what the American Medical Association calls a “traumatic transition.”

Kognito designs simulations with virtual patients with these factors in mind by delivering realistic scenarios and an immersive learning experience to every user. These simulations take less than an hour to complete and many are CNE/CME accredited.

Providers who have completed a Kognito simulation report that they prefer a simulation as a learning tool over the standardized patient model. They feel more comfortable and free to make decisions in a virtual space that they can later apply in practice.

Enhancing the patient experience through better care

Quadruple Aim Patient Experience
Changes in skills as a result of completing a Kognito simulation

The core of Kognito simulations for clinical training are improving patient-provider conversations. Each simulation is built on a foundation of evidence-based communication techniques and medical science.

In replicating a patient visit in an environment with virtual humans, Kognito augments faculty expertise with first-person accounts from practicing clinicians and real patients to build a comprehensive model of real-life provider-patient interactions.

Learners experience the impact of common pitfalls on healthcare discussions and formulate strategies for how best to navigate challenging patient conversations. The result of this focus on patient engagement through building skills like motivational interviewing leads to better interaction with patients, contributing to this goal of the Quadruple Aim.

Reducing per capita cost through improving value

In-person training is expensive. It requires planning, coordination, and additional resources like standardized patients or trainers. Training quality can also vary rather than ensuring replicability. And finally, time away from from the office is often an invisible cost.

With Kognito simulations accessible online, they are scalable across healthcare organizations, and accessible to learners at their own convenience.

Also integrated into every simulation is seamless data tracking. Healthcare providers can instantly assess their own performance, and administrators or schools of health professionals can quickly track data across a group. Online 24/7 access allows for cost-effective implementation.

Improving population health

Quadruple Aim Population Health
Behavior change results of Kognito Simulations

What are some results that healthcare organizations have seen with Kognito simulations? Our simulations include survey data collection to generate insight into changes in users’ skills, knowledge, and behavior.

When it comes to screening and brief intervention of mental health and substance use, for example, our data show a 42% increase in the number of patients screened. This is an important improvement given that not enough patients are being engaged in screening.

In our At-Risk in Primary Care simulation, 49% report an increase in the number of patients screened. Forty percent of practitioners report an increase in discussions with patients about substance use.

Meeting the Quadruple Aim with Kognito

Quadruple Aim with Kognito
Kognito Simulation

An NYU pilot study examined the potential utility of two simulated conversations with virtual humans to promote effective communication and collaborative decision-making between healthcare providers and patients in order to improve health outcomes, including the over-prescribing of antibiotics.

Provider feedback based on the one-month follow-up survey showed:

  • 77% reported that the simulation had a positive impact on the way they communicate with patients
  • 65% indicated that it helped them have a conversation with patients about antibiotics
  • 94% said that they intend to further invite patients to ask questions and participate
  • 89% said they would recommend the simulation to other physicians
  • 100% said they would recommend it to medical students and residents

Looking to improve provider engagement in a way that supports the Quadruple Aim? Learn more about Kognito’s growing portfolio of healthcare simulations here and experience a demo. 


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