Letters to the Editor
To the Editor:
We read with interest Lown and colleagues’1 recent article on integrating a compassionate, collaborative care (the “triple C”) model into health professions education. Their work provides an excellent framework for moving closer to achieving Berwick and colleagues’2 “triple aim” of improving patients’ health and enhancing their experiences of care while concomitantly reducing costs. Organizational psychology suggests, however, that little substantial progress will be made until other issues—adaptive challenges that block changes in behavior—are brought out from the shadows, honestly examined, and coped with creatively and responsibly.3 In medical education and practice (as in other areas that have informed our thinking4,5), these underlying issues commonly form the “triple P” of power, prestige, and profit, especially when valued as terminal objectives on their own.
We are concerned that the “triple P” factors have not yet been explicitly acknowledged and will thus continue to work against the development of compassionate organizational learning and service environments. We suggest that those interested in promoting more humanistic health care explore how power, prestige, and profit both add to and detract from progressive initiatives that support organizational professionalism.6 We encourage them to address these “triple P” factors as an unambiguous step toward transparency and efficacy on their paths to reforming medical education and practice.
William Ventres, MD, MA
Research associate, Institute for Studies in History, Anthropology and Archeology, University of El Salvador, San Salvador; email@example.com.
Jeff McAuliffe, MA
Graduate faculty member, Leadership and Organization Development, Saybrook University, Oakland, California.
1. Lown BA, McIntosh S, Gaines ME, McGuinn K, Hatem DS. Integrating compassionate, collaborative care (the “triple C”) into health professional education to advance the triple aim of health care. Acad Med. 2016;91:310–316.
2. Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health, and cost. Health Aff (Millwood). 2008;27:759–769.
3. Heifetz R, Grashow A, Linsky M. The Practice of Adaptive Leadership. 2009Boston, MA: Harvard Business Review Press.
4. Golub PS. Power, Profit and Prestige: A History of American Imperial Expansion. 2010.New York, NY: Pluto Press.
5. Grönfors M, Stålström O. AIDS and the oppression of homosexual people. Acta Sociologica. 1987;30:53–66.
6. Egener B, McDonald W, Rosof B, Gullen D. Perspective: Organizational professionalism: Relevant competencies and behaviors. Acad Med. 2012;87:668–674.