The Davin Difference: Supporting the Quadruple Aim

11 Jan, 2024

In 2008 Berwick, Nolan, and Whittington introduced the concept of the “Triple Aim” into the lexicon of the healthcare system. What was perceived as a revolutionary concept at the time, held that to improve the healthcare system institutions must simultaneously pursue three dimensions of performance, the Triple Aim being: improve the patient’s experience of care, reduce healthcare cost per capita, and enhance the health of the population.[1] Later in 2014, Dr. Bodenheimer and Dr. Sinsky expanded the initial framework to include a fourth component, adding the goal of improving the work life of health care providers, thus creating the “Quadruple Aim.” [2] This more readily adopted model asserts that improving the work experience of clinicians in turn will allow them to better serve the other three aims.

improve the patient’s experience of care, reduce healthcare cost per capita, and enhance the health of the populationFor well over a decade, the issues of nurse burnout and stress have been increasing, the biproduct of which is emotional exhaustion, compassion fatigue, and a lack of personal attainment within one’s work.[3] The need for the Quadruple Aim could not be timelier as the Covid-19 pandemic continues to disrupt the healthcare system and compound the lasting negative health consequences for caregivers working at the bedside. A workforce that has already been experiencing shortages, now sees these issues intensifying as more nurses leave the profession. Our very own Dr. Bridget Nettleton, PhD, RN, CNE reflects on the importance of prioritizing the wellbeing of healthcare providers from a nurse’s perspective:

As healthcare providers we need to be mindful of self-care, as well as caring for others. Forty years ago, I began my nursing practice in a small community hospital where primary nursing was the model. The staff to patient ratio was six to one, and the registered nurse was responsible for all assessments, interventions, and evaluation of care.

In order to most effectively care for our patients on the thirty-bed orthopedic unit, another new graduate, a licensed practical nurse, an aide and I formed a team and cared for our 18 patients. We were creative and used humor and collaboration as we did our work. While we did not realize it at the time, we practiced mindful self-care which assured the wellbeing of the whole team.

One particular memory comes to mind, when we placed a large stuffed bunny rabbit in one of the beds in traction and made up a care plan for Esther Bunny. The patients, physicians and staff all loved our approach, and it brought a sense of meaningful recognition and value to our work. We felt good about what we accomplished day after day.

Today we must recapture that sense of humor and hope in the workplace. It will not be an easy task but improving the work environment for all healthcare practitioners is of critical importance. As noted in the Academy of Medicine report “The Future of Nursing 2020-2030” we cannot expect nurses and other healthcare providers to provide care that yields positive patient outcomes, if they are also not cared for and valued for the work they do.[4]

As an organization, Davin Healthcare is committed to supporting the Quadruple Aim, with a high focus on the more recently added aim of improving the work-life balance and overall wellbeing of healthcare professionals. The first way in which Davin supports the Quadruple Aim is by adopting the American Association of Critical-Care Nurses’ (AACN) Six Standards of Creating a Healthy Work Environment, namely: skilled communication, authentic leadership, meaningful recognition, appropriate staffing, true collaboration, and effective decision making.[5] As a Managed Service Provider (MSP), Davin is most effective at influencing the parameters of appropriate staffing at healthcare facilities, true collaboration with its healthcare clients and partners, and following authentic leadership practices to encourage positive clinical outcomes with programs designed to support clinical excellence and wellbeing.

Additionally, Davin’s leadership researches and implements health and wellness programs along with resources for its clinical and internal workforce; these resources include free access to Telehealth, Tele mental health, nutrition, stress relief, and a series of on demand exercise programs. The long-term goal to address the challenges of nurse burn-out and attrition is to provide support and engage employees through funding educational opportunities, training, and access to new innovative technologies. Combined, these strategies are designed to provide necessary tools and resources at no cost to enhance the employees’ work-life and overall wellbeing.

As a Nurse-Owned and Nurse-Operated healthcare organization, Davin understands that supporting the clinician’s wellbeing is at the utmost importance in influencing the remaining Triple Aims to help improve the healthcare experience for all those involved. It is through these practices that Davin solidifies its true difference among other organizations in its industry, because not only does Davin understand the challenges healthcare organizations face, but it also actively works to improve the industry at large with the services it provides. To learn more about The Davin Difference and how it can better serve your organization, please visit

[1] Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008 May-Jun;27(3):759-69. doi: 10.1377/hlthaff.27.3.759. PMID: 18474969.

[2] Bodenheimer, T. and Sinsky, C. (2014) From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, 12, 573-576.

[3] Adams, J. M. (2011). The Adams Influence Model (AIM): Understanding the factors, attributes, and process of achieving influence (pp. 9-63). Dudweiler Landstr, Germany: VDM Verlag Dr. Muller GmbH & Co KG.

[4] National Academies of Sciences, Engineering, and Medicine 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press.

[5] AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Am J Crit Care 1 May 2005; 14 (3): 187–197. doi:

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