In 2007 the Institute for Healthcare Improvement presented what is now called the “Triple Aim” as a framework that describes an approach for optimizing health system performance. The institute has indicated that new designs are needed to simultaneously pursue the 3 dimensions of the Triple Aim: (1) improving the patient experience of care (including quality and satisfaction), (2) improving the health of populations, and (3) reducing the per capita cost of health care.1 

The primary focus of the Triple Aim is patient care. Patient care is widely accepted in the United States as an important agenda, but the Triple Aim also has 2 secondary goals: improving the patient experience and reducing costs.2  This article addresses the health care provider’s work environment, the Triple Aim, and the evolution of what is known as the “Quadruple Aim.” Healthy work environments are related to the goals of the Triple Aim. Improvement...

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