Achieving the Quadruple Aim

Telehealth is an opportunity to meet the goals of the Quadruple Aim initiative including improved health outcomes at a lower cost while improving both patient and provider satisfaction. Click on the tabs below for more information:

Overview

Evolving from the Triple Aim of 2007, the Quadruple Aim adds a fourth dimension, focusing on achieving joy, well-being and resilience among care teams. The Institute for Healthcare Improvement’s (IHI) Triple Aim framework, is based on the concept that the patient’s satisfaction has a direct correlation to the well-being and the satisfaction of the healthcare team. The fourth aim, referred to as the workforce wellbeing domain was added to encourage fostering of healthy cultures and teamwork, and recognize that measuring and decreasing burnout of the workforce would improve the quality of the care that is provided. The four tenants of the Quadruple Aim include

Improved Clinical Experience - there is a direct correlation between reported healthcare provider burnout and patient satisfaction,
Better Outcomes - from triple to quadruple aim the focus has moved from specific populations to the whole & global population,
Improved Patient Experience - including safety, effectiveness, patient centeredness, timeliness, efficiency and equity,
Lower Costs - currently 18% of the U.S.’s GDP is spent on healthcare which is primarily disease management. This is a very high per capita cost with great room for improvement.

Qwik-Byte Video

Institute for Healthcare Improvement’s (IHI) Position on the Quadruple Aim

Terminology

Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively)
Efficient: Avoiding waste including waste of equipment, supplies, ideas, and energy of the healthcare team
Equitable: Providing care that does not vary in quality because of a person’s characteristics such as their gender, ethnicity, geographic location, and socio-economic status
Experience of Care Dimension: Experience of care dimension focuses on patient surveys to measure engagement and satisfaction (i.e. CAPS survey), and the set of measures based on key dimensions (i.e. Institute of Medicine’s six aims for improvement: safe, effective, timely, efficient, equitable, and patient-centered)
IHI’s Core Goal: IHI’s core goal is to improve the lives of patients
IHI’s Triple Aim Framework: Introduced in 2007, it is actually a single aim with three dimensions: improve the patient care experience; improve the health of populations; and reduce per capita health care costs
IHI Triple Aim Outcome Measures: IHI Triple Aim has a set of outcome measures, which puts patients at the center of care. Each dimension of IHI’s Triple Aim has subjective and objective outcome measures that provides healthcare organizations a standard set of measures to use for tracking and improvement
Person-Centered (a.k.a. Patient-Centered): Being respectful of and responsive to individual’s preferences, needs, and values, and ensuring individuals’ values guide all clinical decisions
Per Capita Cost Dimension: Per capita cost focuses on total cost per patient and utilization rates
Safe: Avoiding harm to patients from the care that is intended to help them
Timely: Predict delays and obstacles to minimize impact on efficient and timely care

Tips and Takeaways

Achieving the Quadruple Aim means improving consumer experience, cost per capita, population outcomes, and the care team satisfaction with work
Utilize technology to ease the burden on clinicians
Implement methods to build trusting relationships, a key to achieving joy and well-being amongst the care team
Develop a metric for care staff well-being; you can’t fix what you can’t measure
A healthcare system that pursues efficiency, quality & safety in workflow can reduce burnout
Utilize patient feedback to improve consumer and consequently provider experience

Test Your Knowledge

The Institute for Healthcare Improvement’s (IHI) Quadruple Aim framework, is based on the concept that the _____________ satisfaction has a direct correlation to the well-being and the satisfaction of the healthcare team.

Patient

Correct! Patient satisfaction relates to the wellbeing of the healthcare team in both an attributive and causative way. First, when the healthcare team is satisfied, they provide better care through attentiveness and good bedside manner, which in turn improves patient experience. Second, when patients are satisfied with their level of care they often require fewer health appointments, reducing clinical burden which contributes to burn-out

Provider

Incorrect; The Institute for Healthcare Improvement’s (IHI) Triple Aim framework, is based on the concept that the patient satisfaction has a direct correlation to the well-being and the satisfaction of the healthcare team.

Administrator

Incorrect; The Institute for Healthcare Improvement’s (IHI) Triple Aim framework, is based on the concept that the patient satisfaction has a direct correlation to the well-being and the satisfaction of the healthcare team.

None of the above

Incorrect; The Institute for Healthcare Improvement’s (IHI) Triple Aim framework, is based on the concept that the patient satisfaction has a direct correlation to the well-being and the satisfaction of the healthcare team.

Which of the below is NOT one of the four tenants of the Quadruple Aim?

Improved clinical experience

Incorrect; this is one of the domains of the Quadruple Aim framework and refers to the experience of the clinical team including satisfaction, burnout, adequate staffing, etc.

Better outcomes

Incorrect; taking on both a clinical and public health lens, the Quadruple Aim framework focuses on "better outcomes" which includes patient and community-level health outcomes such as morbidity, mortality, re-admissions, among others

Improved patient experience

Incorrect; this is one of the domains of the Quadruple Aim framework and is considered to have the greatest demonstrated impact on clinical experience

Lower costs

Incorrect; this is one of the domains of the Quadruple Aim framework. When improvements in the health system allow services to be provided at lower cost, it can contribute to greater reimbursement for providers and/or increased patient access to services

Improved clinical training

Correct; while important, the Quadruple Aim framework does not emphasize health training but actual healthcare components such as clinical experience, patient experience, and patient outcomes

______________ is defined as “Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those that are likely not to benefit.”

Efficient

Incorrect; efficiency is concerned with the amount of time or energy expended to complete something

Effective

Correct! Effectiveness is concerned with providing the best outcome and measures the degree to which a desired result is achieved

Equitable

Incorrect; equity is concerned with fair outcomes

Additional Resources

10 minute video defining Quadruple Aim with emphasis on patient care experience
The Triple Aim or the Quadruple Aim? Four points from Institute for Healthcare Improvement (IHI) on strategizing a quadruple aim integration
Quadruple Aim White Paper Document from IHI on telehealth as a means to improve provider and patient experience