![]() If adding a workforce dimension to the triple aim pushes this priority to the top of the minds of those with control over system resources, then that is the right thing to do. But the return on this investment will be huge - the cost of vacancies unfilled and turnover in health care is considerable, one estimate of replacing a registered nurse in the US is over $60,000. For too long, all of this has been in the "too hard" box. We need to invest in better working conditions, flexible working practices, enabling shared decision-making and taking with people living with health conditions. And we are not just talking training and development. If policy-makers and senior leaders in the sector could invest a portion of what is being put into digital solution development, AI and machine learning, we might have a hope of a sustainable workforce. Investment in the health and care workforce has been sorely neglected. Without health and care staff that are motivated, engaged, enskilled and empowered, we have no chance of delivering person-centered coordinated care. While this may not be an end goal of health and care systems, to borrow from Julio Frenk's model of health systems, it is a critical intermediate goal. However, from the point of view of influencing policy and practice globally, there is a strong argument for at least including the improvement of the work life of professionals as a fourth aim. ![]() There are reasonable theoretical points on both sides. There is some debate about the triple aim of health and care systems and whether they should be expanded to the quadruple or even quintuple aim.
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