How illuminating, clarifying and contextualising shame can transform healthcare: the shame lens.

Despite widespread efforts to advance the Quadruple Aim, persistent challenges continue to impede progress. One important yet largely unacknowledged contributor may be shame-a complex and deeply human emotion that can profoundly shape behaviours, relationships and organisational dynamics throughout healthcare. In this paper, we propose the 'shame lens' as a novel framework for advancing the Quadruple Aim. We describe three functions of the shame lens: illuminating shame, clarifying shame-driven behaviours and contextualising shame within social and institutional structures, and we discuss their value in advancing health outcomes, healthcare professional well-being and effective organisational dynamics. We incorporate practical strategies for integrating shame-sensitive approaches into healthcare, including education for clinicians and learners, organisational reform and everyday practices that foster respect, accountability and emotional awareness. We ultimately argue that recognising and addressing shame can enhance professional well-being, improve health outcomes and strengthen trust, advancing meaningful progress towards the Quadruple Aim.