Care of the clinician: Addressing the quadruple aim

Nilesh Gokal, MD, Southwest Medical Associates


Southwest Medical, part of Optum, is one of Nevada’s largest multi-specialty medical groups. We’ve been caring for southern Nevadans since 1972. We have decades of experience and a drive to better our patients' lives. 

By combining technology and information, we give our patients the right care in the right setting. We provide primary, specialty, urgent, senior, OB-GYN, pediatric and convenient care. 

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Healthy clinicians are more capable of providing high quality patient care. There’s no controversy in the assertion that happy and healthy workplaces are more likely to retain staff, make fewer mistakes and have higher patient satisfaction.

The idea of creating these workplaces, and aligning with the fourth part of the quadruple aim, “exceptional provider experience,” is gaining ground at the offices of Southwest Medical Associates (SMA).


The challenge of clinician burnout

A rapidly changing U.S. health care system has strained clinicians.

The standardization in quality care led to notable improvements in patient outcomes, but reporting metrics and the advent of the electronic health record (EHR) added administrative tasks and shortened the time that physicians spend doing what brings them satisfaction: patient care. 

With 45% of doctors feeling at least 1 symptom of burnout2  and the cost of replacing a seasoned clinician exceeding $250,0003, it is time to invest in strategies that bring the joy of work back to the clinician.

SMA is implementing well-studied methods in creating positive workplace cultures. Improving communication between colleagues has a significant effect on satisfaction.4

At SMA, getting to know the people you work with goes a long way to making the environment friendly, compassionate and understanding. 

Encouraging communication

As a new employee at SMA, rotating through the office is an opportunity to understand the work that each member of the team performs. This understanding promotes a greater awareness of each person’s contribution to the care of patients. 


In addition, it allows personal contact and friendships to form across work areas and professional lines that would otherwise be difficult to cross. The process humanizes and reverses isolation, key elements to good communication.

As we find ourselves often separated by the walls of our exam rooms, clinician-to-clinician communication is facilitated by weekly meetings. Colleagues can discuss issues of importance, future goals and address any concerns brought to the fore over the past seven days.

Growing resilience

Another proven way to promote wellness at work: teaching resilience. Assuming responsibility for the health of patients is an inherently stressful business, but not necessarily negative. This responsibility is one from which clinicians draw great meaning. 

Resilience is the quality that allows one to celebrate victories and mourn losses appropriately, not succumbing to cynicism or becoming overwhelmed.

As resilience in the medical field is a tall order, intentional practice of mindful awareness is needed to keep clinicians functioning at their healthiest.

SMA has proven their commitment to the teaching and promotion of mindfulness, a key to resilience, by holding monthly “mindfulness meetings,” where we tackle topics like finding time for self-care.  

Daily huddles are also a regular check-in on what is happening in the community of our office. All members participate as we see where we stand on improvements and ensuring that each area of the office is ready to handle the day before us.

Bringing awareness to personal energy levels, the filters we apply in our perceptions, and the shadows we cast, takes only a moment but can change the tenor of a day’s work.

Finding meaning

Those who dedicate themselves to working in the field of medicine have a humanitarian bend, drawn by nature to a profession which imparts a sense of meaning. Amplifying the sense of meaning sought is as simple as recognizing good work.

At SMA, quarterly bonus luncheons include a moment recognizing the above-and-beyond work done by a nominated staff member. Simple but meaningful acts are acknowledged and encouraged. 

Recently, we recognized a medical assistant (MA) who cared for a frail and elderly patient who had forgotten her phone, her only means of communication, in the ridesharing transportation that brought her to the appointment. 

The MA called the rideshare company while the patient saw the doctor. To the patient’s great relief, she had the phone returned and waiting for her by the time she was done.

As clinicians with so many patients under our care, it is easy to forget that we are also human. We are vulnerable to the same issues that we diagnose in our patients every day: depression resulting from isolation, or stress contributing to cardiovascular disease. 

Just as we are able to see the root causes of disease in our patients, we must find and treat the causes of dysfunction in our own places of work. SMA has taken large steps to identify and heal the hectic, disconnected, medical office. 

Our return to discovering the joy of medicine betters each of us as clinicians and in turn, each one of our patients.

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  1. Shanafelt TD, Dyrbye LN, West CP. (2017). Addressing physician burnout: the way forward. Jama, 317(9), 901-902.
  2. Ibid.
  3. Buchbinder, S. B., Wilson, M., Melick, C. F., & Powe, N. R. (1999). Estimates of costs of primary care physician turnover. The American Journal of Managed Care, 5(11), 1431-1438.
  4. Linzer, M., Poplau, S., Grossman, E., Varkey, A., Yale, S., Williams, E., ... & Barbouche, M. (2015). A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) study. Journal of General Internal Medicine, 30(8), 1105-1111.

This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice. 

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