EBP And Quadruple Aim Discussion

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved into a Quadruple Aim by including a focus on improving the work-life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.
To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

Patient experience
Population health
Costs
Work life of healthcare providers

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The Quadruple Aim: care, health, cost and meaning in work

Rishi Sikka,1 Julianne M Morath,2 Lucian Leape3

1Advocate Health Care, Downers Grove, Illinois, USA 2Hospital Quality Institute, Sacramento, California, USA 3Harvard School of Public Health, Boston, Massachusetts, USA

Correspondence to Dr Rishi Sikka, Advocate Health Care, 3075 Highland Avenue, Suite 600, Downers Grove, Il 60515, USA; rishi.sikka@advocatehealth.com

Received 5 March 2015 Revised 6 May 2015 Accepted 16 May 2015

To cite: Sikka R, Morath JM, Leape L. BMJ Qual Saf 2015;24:608–610.

In 2008, Donald Berwick and colleagues provided a framework for the delivery of high value care in the USA, the Triple Aim, that is centred around three over- arching goals: improving the individual experience of care; improving the health of populations; and reducing the per capita cost of healthcare.1 The intent is that the Triple Aim will guide the redesign of healthcare systems and the transition to population health. Health systems glo- bally grapple with these challenges of improving the health of populations while simultaneously lowering healthcare costs. As a result, the Triple Aim, although ori- ginally conceived within the USA, has been adopted as a set of principles for health system reform within many organi- sations around the world. The successful achievement of the

Triple Aim requires highly effective healthcare organisations. The backbone of any effective healthcare system is an engaged and productive workforce.2 But the Triple Aim does not explicitly acknow- ledge the critical role of the workforce in healthcare transformation. We propose a modification of the Triple Aim to acknow- ledge the importance of physicians, nurses and all employees finding joy and meaning in their work. This ‘Quadruple Aim’ would add a fourth aim: improving the experience of providing care. The core of workforce engagement is

the experience of joy and meaning in the work of healthcare. This is not synonym- ous with happiness, rather that all members of the workforce have a sense of accomplishment and meaning in their contributions. By meaning, we refer to the sense of importance of daily work. By joy, we refer to the feeling of success and fulfilment that results from meaning- ful work. In the UK, the National Health Service has captured this with the notion of an engaged staff that ‘think and act in a positive way about the work they do, the people they work with and the organ- isation that they work in’.3

The evidence that the healthcare work- force finds joy and meaning in work is not encouraging. In a recent physician survey in the USA, 60% of respondents indicated they were considering leaving practice; 70% of surveyed physicians knew at least one colleague who left their practice due to poor morale.2 A 2015 survey of British physicians reported similar findings with approximately 44% of respondents reporting very low or low morale.4 These findings also extend to the nursing profession. In a 2013 US survey of registered nurses, 51% of nurses worried that their job was affect- ing their health; 35% felt like resigning from their current job.5 Similar findings have been reported across Europe, with rates of nursing job dissatisfaction ranging from 11% to 56%.6