in this simulation, its time for a marketing audit! Bright Road Health Care System wants to see how responsive they are to market needs and preferences, and if their marketing strategies are showing a good return on investment. You are a marketing consultant who has been brought in as an objective party to perform this audit. Once the information is gathered, you will identify the top 3 strengths and the top 3 weaknesses of the organization. Then, you will make prioritized recommendations to turn the weaknesses into strengths. As you prioritize your recommendation, be sure to answer the following:

Instructions - Answer the following and include these concepts in your recommendation.

We read about the Triple Aim and Quadruple Aim concept this week. What is the Triple Aim concept and what are the three aims involved? How has the adoption of the Triple Aim benefited from improvements in technology? Why have some health care providers been unable to fully implement the Triple Aim?

How can the expansion of the Triple Aim to the Quadruple Aim be a solution to any obstacles of the pursuit of the Triple Aim?

Discuss how your recommendation for Bright Road would work toward the goal of the Triple and Quadruple Aim of improving population health and reducing physician and staff burnout. Include the details of your recommendation with a focus on how you would use social marketing as a part of Bright Road Health Care Systems CQI initiative.

From Triple Aim to

Quadruple Aim

An important innovative concept that was first

introduced in 2008 is the Triple Aim of Health

Care (Berwick, Nolan, & Whittington, 2008).

This innovation broadens the goals and definition

of quality health care through the simultaneous

pursuit of three aims: improving the

experience of care, improving the health of

populations, and reducing the per capita costs

of health care (Berwick, Nolan, & Whittington,

2008, p. 759). Since its introduction, the

adoption of the Triple Aim has become a goal

of many health care providers both nationally

and globally and can be viewed as a new stage

in the ongoing evolution of CQI in health

care; it has done so by using a systems optimization

perspective and has taken advantage

of associated innovations that have facilitated

the implementation of systems to pursue the

Triple Aim. For example, adoption of the Triple

Aim has benefited from improvements in

technology, such as the broader overall use

and the institutionalization, at least in large

hospital systems, of electronic health records.

It has also benefited from CQI tools and techniques

that have become more widely adopted

in recent years such as elimination of waste

in health care processes via LEAN/Six Sigma,

described in Chapter 5.

The introduction of the Triple Aim is

an example of innovation in health care

systems, and the application of a systems

approach utilizing synergy derived from the

interdependence of the three aims. However,

this interdependence requires careful attention

to system optimization since changing

any one has a direct impact on the other

two aims. This important characteristic has

direct implications on the further adoption

of CQI in health care, which requires that

intrinsic motivation for change and improvement

is maintained by providers. For example,

if cost reductions lead to overburdening

busy providers with lower leverage tasks,

then they may not be motivated to identify

Factors Associated with Successful CQI Applications 41

facebook.com/LinguaLIB

vk.com/lingualib

and implement new CQI ideas. The costreduction

mentality that is described in some

business models as doing more with less

can also lead, in health care, to poorer quality

and lower patient satisfaction if tradeoffs are

not carefully understood and managed.

Quadruple Aim

Although many health care providers have

adopted the Triple Aim, others have not been

able to do so successfully. One explanation

for less than full implementation may be that

practices working toward the Triple Aim may

increase physician burnout and thereby reduce

their chances of success (Bodenheimer &

Sinsky, 2014, p. 575). A partial explanation for

this trend is that some of the very same factors

that lead to successful adoption of the Triple

Aim may have inadvertently led to burnout and

demotivation among some health care providers.

For example, the widespread increase in

utilization of electronic health records, a plus

factor for implementing the Triple Aim, has

been shown to lead to increases in burnout

(Babbott et al., 2014).

Provider burnout and dissatisfaction, the

opposite of internal motivation and engagement,

may also lead to a reluctance to adopt

or lead the development of innovations/CQI

initiatives. Because of its possible causative

links to burnout, the Triple Aim, while by definition

designed to lead to greater CQI implementation

and innovation in health care, may

inadvertently have the opposite effect, at least

in some cases.

To address this conflict in positive and

negative effects of pursuing the Triple Aim, one

solution that has been proposed is to expand the

Triple Aim by adding a fourth aim improving

the work life of clinicians and health care staff

and increasing the experience of joy and meaning

in health care work ( Bodenheimer &

Sinsky, 2014; Sikka, Morath, & Leape, 2015).

The key question is, how?

As with many CQI initiatives the solution

of expanding from a Triple Aim to a Quadruple

Aim must start with a system-level focus. For

example, one form of system optimization that

is proposed to implement the Quadruple Aim

for primary care is to shift relevant responsibilities

from physicians to practice staff but

at the same time ensuring that staff who

assume new responsibilities are well trained

and understand that they are contributing to

the health of their patients and that unnecessary

work is reengineered out of the practice

(Bodenheimer & Sinsky, 2014, p. 575). This

approach represents just one of many possible

system changes that can be included under the

umbrella of empowerment, a well-established,

cost-effective approach to improve internal

motivation and engagement (Daft, 2015).

It also requires attention to the concept of

task-relevant maturity for ensuring that those

who are empowered are prepared to accept

greater responsibility, including receiving adequate

training (Grove, 1995). The successful

application of these concepts may require an

initial investment in dollars and time that will

offer a future return on investment. And most

important, it requires a culture that is open to

transformational leadership concepts (Daft,

2015) such as empowerment and a vision that

embraces innovation and improvement; such

a culture is described in the next section of

this chapter.

In summary, the concept and effectiveness

of the Triple Aim will be further

improved by the addition of a fourth aim that

focuses on the welfare of providers because

maintaining a balance between workforce

satisfaction and patient satisfaction will be

critical in achieving the fourth aim. Reductions

in physician and staff burnout will

support the primary goal of the Triple Aim,

improving population health (AHRQ, 2015).

Stated more succinctly, health care is a

relationship between those who provide

care and those who seek care, a relationship

that can only thrive if it is symbiotic

(Bodenheimer & Sinsky, 2014, p. 575). And

this symbiotic relationship is at the core of

successful CQI implementation.