![]() The second real disruption is the lower per capita cost part of the Triple Aim. Adopting the Triple Aim implies a major shift in process. Whittington and Nolan said, “Yes.” Hospitals don’t have a plan, mostly, to work on the causes of heart attacks they work on the heart attacks. Does that mean I’m supposed to work on housing and transport and racism? We know that racism is the enemy of health. We know that good health depends on good transportation. Is that really my job? We know that bad housing causes poor health. It’s disruptive to tell a hospital or even the health care enterprise as a whole, “You’ve got a second job,” which is to address the health of populations. The first component of the Triple Aim - better care of individuals - that’s our sweet spot. One, it forces health care delivery out of its own box. Why did so many people think the Triple Aim was a radical idea when it was first proposed?Ī lot of people thought - and possibly many of them still do - that the Triple Aim is a very radical idea for a couple of reasons. LEARN MORE: IHI Summit on Improving Patient Care, April 11–13 in I got to co-author the paper about it, but it’s always embarrassed me that people often think I came up with it. Their framing became known as the Triple Aim. It’s like a compass that helps us define success. Whittington and Nolan posited this system of aims - better care for individuals, better health for populations, and lower per capita cost - as a more complete statement of the social need here to fill. Government may need to put money into roads or schools. A corporation maybe want to be more competitive and pay its workers more. People may need to pay a college tuition. That is because the needs of the people we serve go beyond health care. The third aim they included, which I think was particularly brilliant, is while reducing per capita cost. The second aim is better health for the population. The first aim is the better experience of care. Whittington and Nolan asserted that, “Society also needs us to help you stay healthy.” They included that second component. The cause of illness isn’t the absence of health care health care’s a repair shop. The causes of these health burdens don’t lie in health care. Why do you have your heart attack? Why did you break your arm? Why are you depressed? Those properties should be there in the individual experience of care when we care for your heart attack, your broken arm, your depression, or you get your checkup.” They identified another component they called the health of the population. Those aims apply when you need or use the care. Whittington and Nolan said, “No, wait a minute. Efficiency - Don’t waste money, space, or any other resources.Equity - Close racial and socioeconomic gaps in health and.Timeliness - Let’s have no delays that aren’t instrumental.Patient-centeredness - Honor me as an individual.Up until that time, the best answer would have referenced the Institute of Medicine Crossing the Quality Chasm report which had laid out six dimensions of need they called Aims for Improvement. So, what would society say it’s hiring health care to do? That’s the key initial question in quality. ![]() They lie in the world of the people we help, the customer, the patient, the consumer. The proper way to think about goals is that they’re external to the organization, external to the industry. You can’t define or pursue quality if you don’t know your aims. The goal they had in mind was to articulate, in a very cogent way, the aims of health care from the viewpoint of the society it serves. The Triple Aim was the brainchild of two of IHI’s faculty, John Whittington and Tom Nolan, who came up with it in about 2006. In the following interview, he describes the societal role of the Triple Aim, comments on the so-called quadruple aim, and describes how the Triple Aim continues to surprise him. ![]() While IHI President Emeritus and Senior Fellow Don Berwick may not be the originator of the Triple Aim, he has been its most visible proponent for over a decade.
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