We bring mindfulness to the world of elite performance. Our work in healthcare caring for the caregivers and anyone else whose individual performance impacts organizational excellence protects the Triple Aim of enhancing patient experience, improving population health, and reducing costs.




In order to help one another toward optimal health and elite performance team members need to respect one another – valuing the life experience and input of coach and team member alike.


Every team member comes in at a starting point that is unique.  The ups and downs of the journey to great health and elite performance will also be unique to each team member.   We accept where our fellow team members are at every phase of the journey, offering unconditional support.

Present Moment Attention

Abraham Lincoln said, “If we could first know where we are, and whither we are tending, we could then better judge what to do and how to do it.”  Present moment attention, also called mindfulness, helps us “know where we are” so we can clearly see our way forward.



The function of protecting and developing health must rank even above that of restoring it when it is impaired.
— Hippocrates, the Greek physician and the father of modern medicine

Dr. Don Berwick and colleagues put forward a Triple Aim for healthcare that includes enhancing patient experience, improving population health, and reducing costs. He now makes the case that advances toward the Triple Aim need to be protected by addressing burnout in healthcare. Others have called for a “Quadruple Aim” that adds the goal of improving the work life of health care providers (1).  A fourth aim that returns joy to medicine is needed because burnout in healthcare erodes the Triple Aim.

As Dr. Berwick states: "In any service industry, let alone one that is dependent on compassion, the customer, the person you are helping isn't going to experience excellence in the hands of a demoralized staff...We will be making a big mistake if we continue on a trajectory of healthcare which continues to erode the energy and self-confidence and joy - that is the right word - of the people who are doing the work of caring."

Burnout is associated with lower patient satisfaction (1).  As more and more people involved in doing the work of caring suffer from burnout, it is more and more likely that patients seeking care will be treated like objects.  This dangerous symptom of burnout – treating patients like objects – must be rooted out if other health improvement efforts are to take hold.

Burnout is a syndrome characterized by feelings of cynicism (depersonalization – or treating people like objects), loss of enthusiasm for work (emotional exhaustion), and a low sense of personal accomplishment (2).  54% of US physicians report at least one symptom of burnout (3), 34% of hospital nurses report burnout (4), and 60% of healthcare employees report job burnout (1).   

The problem of burnout in healthcare is rapidly increasing.  Researchers at the Mayo Clinic surveyed physicians in studies published in 2012 and 2015- reporting in 2012 that 45.8% of surveyed physicians reported at least one symptom of burnout (2) , and in 2015 that 54.4% of physicians had experienced at least one symptom of burnout (3).  Symptoms of physician burnout are associated with (1,5,6):

  • Increased rates of medical errors
  • Riskier prescribing patterns
  • Lower adherence to chronic disease management plans
  • Lower patient satisfaction

Any effort to improve care and ensure patient safety is clearly compromised by healthcare providers who suffer from burnout.  In addition, the lives of those with burnout are at risk.  Professional burnout is associated with (2,7):

  • Alcohol use
  • Suicidal ideation
  • Transition out of healthcare or early retirement

Healthcare leaders navigating by the Triple Aim of enhancing patient experience, improving population health, and reducing costs must now consider adding a fourth aim of improving the work life of those working in health care and returning joy to medicine. Those decision makers who initiate Fourth Aim Training system wide take steps to address burnout in healthcare by delivering mindfulness-based resiliency training to anyone involved in the work of caring.


1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12:573-576.

2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385.

3.Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-13.

4. McHugh MD, Kutney-Lee A, Cimiotti JP, et al. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff (Millwood). 2011;30(2):202-210.

5. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714-1721.

6. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000.

7.  Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy. Rand Corporation 2013.