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Status of the Quadruple Aim in Healthcare

June 7, 2024

by Steve Albers, Vice President, Healthcare Sales

Quadruple Aim: Introduction & Objectives

Quadruple Aim (QA) is a four-dimensional framework that has effectively been implemented into primary healthcare practice. Introduced by the Institute for Healthcare Improvement (IHI) in 2008 as the ‘Triple Aim’ of healthcare delivery, it was later developed into a four-dimensional model to become the Quadruple Aim.

For healthcare delivery, the QA necessitates the adoption of the following four principles:

Figure 1: Benefits of the Quadruple Aim for Healthcare Organization

QA: From a Theoretical Concept to Successful Mainstream Practice

The Quadruple Aim was purely an academic concept until it was introduced in the health services literature in 2008, and within a decade and a-half of its introduction, it became the cornerstone of primary healthcare delivery reform.

The fact that the Quadruple Aim model has widely been applied to practice implies that healthcare professionals, particularly primary care physicians, can significantly contribute to the development of a health-conscious society by broadening their sphere of influence in the promotion of population health. In other words, primary care physicians can utilize the built-in synergies between the Quadruple Aim and the Culture of Health action models because of their position in the healthcare system, which could accelerate the pace of development towards achieving a culture of health.

The two primary reasons for successfully integrating the Quadruple Aim into mainstream practice were:

  • The active efforts of physician leaders in promoting the concept across the healthcare industry.
  • The complementary role that the Affordable Care Act (ACA) plays in consolidating the progress.

Though it relates to the Quadruple Aim, it is important to remember that the ACA lacks specific measures for addressing the social determinants of health and health disparities.


Pursuing Health Equity: The Bullseye of Quadruple Aim


The Quadruple Aim included improvements to the work-life balance and experiences of physicians and care teams that deliver patient care, in addition to the original goals of improving patient experience, cost reduction, and optimizing population health. Therefore, the true north for optimal health system performance was codified and is now reflected in the Quadruple Aim. This was immediately followed by and further sparked by emerging literature on the enormous financial, clinical, and workforce impact of clinician burnout, evolving clinical settings focused on population health, and national alternative payment models for advancing primary care delivery in new ways.

Health equity is defined by the World Health Organization as the absence of avoidable, unjust, or correctable discrepancies between groups of individuals, regardless of how those groups are classified through stratification—social, economic, demographic, geographic, or otherwise. Therefore, the objective of health equity is to ensure that everyone has an equal opportunity to realize their full health and that no one is prevented from doing so.

Aiming for health equity as a distinct objective is like hitting the bullseye for all the other objectives.

Strong intentionality must be present in all the areas of health care practice, research, education, training, and participation if health equity is to be achieved. This means demolishing and unlearning the entire curriculum, care models, and treatment guidelines before rebuilding them with a health equity lens or framework.

The Path Forward

Health has traditionally been associated with the ability to live an active and healthy life supported by one’s job, family, and community, rather than the requirement to seek medical attention.

By pursuing the Quadruple Aim and working to promote workforce engagement, hospitals can successfully enhance patient outcomes and experiences while reducing costs. This illustrates how focusing on employee engagement and experience will help achieve the Quadruple Aim in its entirety.

At present, the health care system has many resources needed to pursue health equity. Focusing on health equity as the target could be the key to achieving the Quadruple Aim. The desire to achieve health equity is a powerful motivator to overcome fear and inertia.

Key Contributor: Geetanjali Negi, Senior Manager – Content/Research & Sales Enablement


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