I n 2007 the Institute for Healthcare Improvement presented what is now called the "Triple Aim" as a framework that describes an approach for optimizing health system performance. The institute has indicated that new designs are needed to simultaneously pursue the 3 dimensions of the Triple Aim: (1) improving the patient experience of care (including quality and satisfaction), (2) improving the health of populations, and (3) reducing the per capita cost of health care. 1 The primary focus of the Triple Aim is patient care. Patient care is widely accepted in the United States as an important agenda, but the Triple Aim also has 2 secondary goals: improving the patient experience and reducing costs. 2 This article addresses the health care provider's work environment, the Triple Aim, and the evolution of what is known as the "Quadruple Aim." Healthy work environments are related to the goals of the Triple Aim. Improvement of the work environment provides an opportunity to promote joy in the workplace. Interventions to improve the work environment of health care providers are consistent with the Healthy Work Environment standards of the American Association of Critical-Care Nurses (AACN). 3 Healthy Work Environments and Patient SafetyHealth care organizations are seeking ways to improve the work environment because research has shown a direct link between a healthy work environment and patient safety. 4,5 Problems in nurses' work environments can lead to feelings of being overwhelmed at work, emotional exhaustion, and burnout. Lyndon 6 has reported that burnout is common among health care workers and that the characteristics of the health care environment that contribute to burnout include time pressure, lack of control over work processes, role conflict, and poor relationships between professional groups and with leadership. Other factors contributing to stress and burnout are lack of support for the staff

Content analysis is a research method that was traditionally utilized by communication scholars, but as the study of media messages has grown, scholars in other fields have increasingly relied on the methodology. This paper reports on a systematic review of studies using quantitative content analysis methods to examine health messages in the mass media, excluding the Internet, from 1985 to 2005. We searched for health-related content analysis studies published in peer-reviewed journals, identifying 441 articles meeting inclusion criteria. We examined article attributes including theories used, topics, media type, and intercoder reliability measures, and looked at differences over time. Our findings show that studies focusing on health-related messages increased from 1985 to 2005. During this time, studies primarily examined magazines, television, and newspapers, with an emphasis on topics related to substance use, violence, sex, and obesity and body image. Results suggest that studies published in communication journals are significantly more likely to include intercoder reliability data and theory discussion. We recommend that all publications, regardless of discipline or impact factor, request the inclusion of intercoder reliability data reported for individual variables, and suggest that authors address theoretical concepts when appropriate. We also encourage authors to include the term "content analysis," as well as media type and health topic studied, as keywords to make it easier to locate articles of interest when conducting literature searches.

Alarm fatigue has been linked to patient morbidity and mortality in hospitals due to delayed or absent responses to monitor alarms. We sought to describe alarm rates at 5 freestanding children's hospitals during a single day and the types of alarms and proportions of patients monitored by using a point-prevalence, cross-sectional study design. We collected audible alarms on all inpatient units and calculated overall alarm rates and rates by alarm type per monitored patient per day. We found a total of 147,213 alarms during the study period, with 3-fold variation in alarm rates across hospitals among similar unit types. Across hospitals, onequarter of monitored beds were responsible for 71%, 61%, and 63% of alarms in medical-surgical, neonatal intensive care, and pediatric intensive care units, respectively. Future work focused on addressing nonactionable alarms in patients with the highest alarm counts may decrease alarm rates.