Can Patient–Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review

  • Marie C. HaverfieldEmail author
  • Aaron Tierney
  • Rachel Schwartz
  • Michelle B. Bass
  • Cati Brown-Johnson
  • Dani L. Zionts
  • Nadia Safaeinili
  • Meredith Fischer
  • Jonathan G. Shaw
  • Sonoo Thadaney
  • Gabriella Piccininni
  • Karl A. Lorenz
  • Steven M. Asch
  • Abraham Verghese
  • Donna M. Zulman



Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient–provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience).


We sourced data from PubMed, EMBASE, and PsycInfo (January 1997–August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient–provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider–patient dyad), and quadruple aim outcomes.


Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands.


Simple, low-demand patient–provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.


interpersonal interventions quadruple aim systematic review patient–provider communication 



We would like to acknowledge Ted Miclau, Laura Jacobson, Shreyas Bharadwaj, and Isabella Romero for their assistance in data analysis and synthesis. We would also like to acknowledge Amrapali Maitra, Sheila Lahijani, and Lars Osterberg for their insightful contributions to this research study.

Funding Information

This study was supported by a grant from the Gordon and Betty Moore Foundation (#6382, Zulman & Verghese, PIs) and a grant from the Arthur Vining Davis Foundation. Drs. Haverfield and Schwartz are supported by VA Palo Alto Center for Innovation to Implementation (Ci2i) HSR&D postdoctoral fellowship.

Compliance with Ethical Standards

Conflict of Interest

There are no conflicts to disclose.

Supplementary material

11606_2019_5525_MOESM1_ESM.docx (840 kb)
ESM 1 (DOCX 839 kb)


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Copyright information

© Society of General Internal Medicine 2020

Authors and Affiliations

  • Marie C. Haverfield
    • 1
    • 2
    Email author
  • Aaron Tierney
    • 3
  • Rachel Schwartz
    • 1
    • 2
  • Michelle B. Bass
    • 4
  • Cati Brown-Johnson
    • 5
  • Dani L. Zionts
    • 5
  • Nadia Safaeinili
    • 5
  • Meredith Fischer
    • 5
  • Jonathan G. Shaw
    • 5
  • Sonoo Thadaney
    • 3
  • Gabriella Piccininni
    • 3
  • Karl A. Lorenz
    • 1
    • 5
  • Steven M. Asch
    • 1
    • 5
  • Abraham Verghese
    • 3
  • Donna M. Zulman
    • 1
    • 5
  1. 1.Center for Innovation to Implementation (Ci2i)VA Palo Alto Health Care System (152-MPD)Menlo ParkUSA
  2. 2.Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP)StanfordUSA
  3. 3.School of MedicineStanford UniversityStanfordUSA
  4. 4.Countway Library of Medicine, HarvardBostonUSA
  5. 5.Division of Primary Care and Population HealthStanford University School of MedicineStanfordUSA

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