Nurs Forum. 2020;55:54–64.wileyonlinelibrary.com/journal/nuf54 | © 2019 Wiley Periodicals, Inc.
DOI: 10.1111/nuf.12382
OR I G I NA L AR T I C L E
Implications for policy: The Triple Aim, Quadruple Aim,and interprofessional collaboration
Natalie Bachynsky PhD
East Texas Medical Center Crockett, Crockett
Medical Center Clinic, Crockett, Texas
Correspondence
Natalie Bachynsky, PhD, East Texas Medical
Center Crockett, Crockett Medical Center
Clinic, 1050 E. Loop 304, suite 200, Crockett,
TX.
Email: n.bachynsky@crockettmedicalcenter.
com
Abstract
Healthcare delivery in the Unites States stimulates policy change at a rapid pace. The
Patient Protection and Affordable Care Act of 2010 (ACA) is intended to expand
access to care and ultimately improve the health of Americans. The Triple Aim,
created by The Institute for Healthcare Improvement, delineates policy implications
for improving population health, the healthcare experience, and per capita cost. The
Quadruple Aim adds a fourth policy implication, for example, addressing the needs of
the healthcare provider. Advanced practice registered nurses are key in carrying out
the goals of the ACA and achieving the Triple and Quadruple Aims, via the formation
of interprofessional teams. This article offers insight into these policy implications
and identifies filters through which related nursing policy will be developed.
K E YWORD S
advanced practice, interprofessional education, policy/politics, quality improvement, social
determinants of care
1 | INTRODUCTION
Advanced practice registered nurses (APRNs) play an integral role in
the development of health policy for our nation. Fortunately, the
number of APRNs is growing rapidly and will continue to grow as the
demand for health promotion policy and interprofessional healthcare
services increas
es. In 2012, the Bureau of Labor Statistics (BLS)
estimated that employment of APRNs would increase 31% by the
year 2022. By comparison, the average growth rate for all employ-
ment groups was only projected to be 11% by 2022.1 APRNs must be
prepared to develop policy that considers the implications of the
patient’s health care needs and psychosocial, environmental, and
financial resources. When APRNs have access to advanced treat-
ments and therapies for patients but high costs prevents them from
obtaining the most effective treatments, both the APRN and the
patient suffer negative outcomes.
The Institute for Healthcare Improvement (IHI) was founded in
1991 in Cambridge, Massachusetts, by a team of forward‐thinkinghealthcare professionals focused on cultivating healthcare policy.
Policy implications demanded improved care for patients while
enhancing interprofessional processes that included APRNs, while
providing health care in a seamless manner. The initial IHI team, led
by Dr. Don Berwick, was committed to redesign the healthcare
system. Policy implications demanded that this system be free of
errors, waste, delay, and unsustainable costs.2 The IHI has evolved
from a small, grant‐funded organization focused on researching and
disseminating evidence‐based practices, to a self‐sustaining enter-
prise committed to leading policy initiatives on major factors that
transform healthcare delivery, that is, incorporate the patient’s
experience and cost of care.
2 | THE TRIPLE AIM
In 2008, The Institute for Healthcare Improvement (IHI) created The
Triple Aim:
A framework for optimizing health system performance
by simultaneously focusing on the health of a popula-
tion, the experience of care for individuals within that
population, and the per capita cost of providing that
care.2