Becker's Clinical Quality & Infection Control

17 Executive Briefing The Role of Nurses in the Triple Aim I n the continuous movement toward higher levels of quality, safety and cost effectiveness, hospitals and health systems strive to meet a number of patient- and systems-related goals. In 2007, the Institute for Healthcare Improvement pro- posed a theoretical model — the Triple Aim, which collapsed the various goals to an interdependent set of three. The model suggests that U.S. healthcare system performance improve- ment will come through the simultaneous pursuit of improving the broadly defined experience of care, improving the health of populations and reducing the per capita cost of health care. The Triple Aim became a fundamental component of health- care reform under the Affordable Care Act. More recently, it has been suggested that an additional aim, improving health- care providers' work lives — making it a quadruple aim — is needed if the model is to produce a transformed healthcare system. The Triple Aim plays a key role in the lives of healthcare profes- sionals across the country, including those of nurses. Here, F. Patrick Robinson, PhD, RN, dean of Minneapolis-based Capella University School of Nursing and Health Sciences, reflects on nurses' role in the Triple Aim and how institutions are support- ing nurses' ability to impact Triple Aim initiatives. Question: How do nurses play a role in each aspect of the Triple Aim? Patrick Robinson: Nurses play key leadership roles inde- pendently and as members of an interprofessional team in driving toward the Triple Aim. Improving the experience of care means far more than satis- faction. What we're talking about is care that's safe, effective, patient-centered, timely, efficient and equitable. In terms of nursing's role in that, nurses represent the largest number of healthcare workers in the U.S. healthcare system. Given our continuous contact with patients, we have an enormous role in assuring that all the dimensions of the experience of care are addressed in a comprehensive and coordinated manner. For example, we manage the process of transitioning patients to and from places and levels of care, a time when many errors could be made and inefficiencies introduced if there is poor communication and coordination. Moving on to improving the health of populations, a population can be broadly or narrowly defined based on a number vari- ables, including demographics, disease states, culture, geog- raphy or even behavioral choices. Population health improve- ment includes figuring out where problems occur and where interventions will have significant aggregate impact. Nurses are placed strategically within the healthcare system to understand its nuances and direct strategies at health promotion, disease prevention and progression, and restorative health. Healthcare costs without reference to a population are not that meaningful. The per capita aspect means decreasing the cost of healthcare per the population, so there are more resources that can be used on other common good initiatives. Nurses make decisions on various aspects of resource utilization, including equipment use and readiness to make a transition of care, which can significantly drive up the cost for a particular population or individual. As such, nurses are in prime positions to decrease cost. However, it's important to understand it's not three separate aims — it's a Triple Aim. The Triple Aim is a singular concept. If one would pursue only one of the aims, you could throw one of the other aims off. It's the simultaneous pursuit of all three parts of the Triple Aim that will result in improved performance. Q: Do nurses play a bigger role in one aspect of the Triple Aim than in the two others? Why or why not? PR: Our disciplinary perspective may lead us toward one or the other, but that way of thinking is problematic. The nursing model of care is holistic. Nurses are not only skilled knowledge workers, but also compassionate caregivers. We have rightfully earned the trust of the public as evidenced by our consistent top Gallup poll ratings on honesty and ethical standards. That likely did not happen because we've focused on the per capita cost of care. Some nurses may bristle regarding that part of the Triple Aim — the per capita cost of care. But by focusing solely on the experience of care, you could exponentially increase the per capita cost. The education and professional formation within our academic programs and our continuing daily dialogues have to move away from the idea that you can hit one prong without hitting the others. For many nurses and other healthcare professionals, true trans- formation will start with significant shifts in ways of thinking. We are a fiercely individualistic society — it's all about us, our healthcare and what we have access to. In our professional lives, it's about this patient and this singular episode of care. These foci have driven us to a high standard of care and tech- nology, but low levels of quality and poor overall outcomes when you consider where we're ranked compared to similarly economically developed countries accompanied by limited access and out-of-control spending. Sponsored by:

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