EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIMS 2

Evidence-Based Practice and the Quadruple Aims

Healthcare organizations are constantly looking for ways to improve healthcare
performance. In 2007, the Institute of Healthcare Improvement introduced Triple Aims, a set
of three targets whose achievement would significantly improve patient lives (Sikka, Morath
& Leape, 2015). These aims are improvement of patient experience, improvement of
population health, and reduction in per capita costs of healthcare. Later, a fourth aim was
added – well-being of healthcare providers (Sikka et al., 2015). Triple Aims, therefore,
became Quadruple Aims. This paper examines whether evidence-based practice (EBP) can be
used to achieve the Quadruple Aims. It will show that application of EBP significantly
improves the ability of healthcare organizations to achieve the quadruple aims.

Analysis

Evidence-based practice is a patient care approach that involves use of scientific
evidence to make decisions in clinical settings (Crabtree et al., 2016). It integrates evidence
from well-designed and independent scientific research, patient experience, and clinical
research (Crabtree et al., 2016). Even though evidence-based practice has been applied in
various industries, it is only in the 1990s that it started being used widely in the healthcare
industry (Sikka et al., 2015). As an effective problem-solving approach, evidence-based
practice can be applied in healthcare facilities to help in the achievement of Quadruple Aims.
When applied in healthcare settings, EBP can improve patient experience, reduce healthcare
costs, improve well-being of healthcare providers, and reduces healthcare costs.
Patient Experience
Patient experience of care relates to efficiency, effectiveness, timeliness, and safety of
care that patients receive (Sikka et al., 2015). It also relates to how patient-centeredness the
care is. Evidence-based practice provides healthcare providers with the latest research

EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIMS 3
information regarding the most effective interventions for various conditions and practices
that reduces medical errors (Crabtree et al., 2016). Thus, thanks to evidence-based practice,
healthcare providers are able to improve patient experience of care that is characterized by
high levels of effectiveness and safety.
Population Health
Improving population health involves use of interventions that achieve specific health
outcomes, such as reducing mortality rates, and reducing disease burden, such as reducing the
prevalence of various chronic conditions (Sikka et al., 2015). It also involves promotion of
healthy behaviors, such as refraining from alcohol consumption and smoking. Evidence-
based practice provides healthcare providers with knowledge of health conditions that are
prevalent in a target population. It also provides them with knowledge of reasons why the
condition is prevalent in the population and the most effective interventions to reduce the
prevalence of the condition (Crabtree et al., 2016). Thus, application of evidence-based
practice significantly improves population health.
Costs
The third element of Quadruple Aims is reduction of healthcare costs or keeping the
costs constant while at the same time improving patient care outcomes. While application of
evidence-based practice often involves investment by the healthcare organization, it leads to
overall reduction in healthcare costs (Sikka et al., 2015). This is because evidence-based
practice usually leads to provision of quality services to patients thus significantly improving
patient outcomes. When patient outcomes are improved, the patients are less likely to be
readmitted. Readmissions significantly increase costs both for the patients and the healthcare
organizations. In fact, under the Affordable Care Act, healthcare facilities get penalized when
patients are readmitted for the same condition with thirty days of discharge (Jacobs et al.,

EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIMS 4
2018). Thus, by improving patient outcomes through helping to offer superior quality of
services, evidence-based practices help patients and healthcare organizations to reduce
healthcare costs.
Work Life of Healthcare Providers
The reason work life of healthcare providers was added to Triple Aims to make them
Quadruple Aims was because of the realization that satisfied healthcare providers are key to
improvement of patient outcomes (Kim et al., 2016). Improving work life of healthcare
providers involves, among others, reducing documentation burden and clinical burnout.
Evidence-based practice can help achieve this aim through recommending the best shift
programs to reduce clinical burnout and encourage healthcare organizations to adopt
technologies that reduce paperwork, such as electronic health records (EHR) (William,
Facmpe & Wilhoit, 2016). EBP is, therefore, effective in improving work life of healthcare
providers.

Conclusion

There is ample evidence that supports the use of evidence-based practice in achieving
the Quadruple Aims and, therefore, achieving their ultimate goal – improvement of patient
lives. Healthcare providers should, therefore, be encouraged to use evidence-based practice in
healthcare settings. This can be done through addressing factors that hinder application of
evidence-based practices, such as lack of understanding of its procedures, lack of investment
in the practices, and lack of time.

EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIMS 5

References

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through
nursing engagement in evidence-based practice. Worldviews on Evidence-Based
Nursing, 13(2), 172–175. doi:10.1111/wvn.12126.
Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in
well-being: moving from the triple aim to the quadruple aim. Nursing administration
quarterly, 42(3), 231-245
Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016).
Predictors of evidence-based practice implementation, job satisfaction, and group
cohesion among regional fellowship program participants. Worldviews on Evidence-
Based Nursing, 13(5), 340–348. doi:10.1111/wvn.12171
Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and
meaning in work. BMJ Quality & Safety, 24, 608–610. doi:10.1136/bmjqs-2015-
004160
William J., Facmpe, S. C., & Wilhoit, G. (2016). Provider burnout and patient engagement:
the quadruple and quintuple aims. The Journal of medical practice management:
MPM, 31(6), 359.