This attempt at change is a desperate strategy for recovery and repair and, as Collins points out in How The Mighty Fall, it often comes too late. After the prediction that the status quo will fail us has come true and we find that we are surrounded by the rubble that remains, then change is the only option. The other form of loss as motivation is acceptance of change after the fact of a loss. Change occurs in this instance to avoid a burning or exploding platform that is usually economic. People who change to avoid loss have made a decision to change after considering the alternative of staying with the status quo. First is a variation of what behavioral economists call “loss avoidance”. Two factors explain why change finally occurs: loss and aspiration. The remaining barriers are not technical they are political. It is the emotional angst associated with change that is the origin of the “political barriers” referred to by the authors when they say: It is the mindset that says I must be careful or I will be hurt or experience a personal loss. The barriers are self interest at every level and the status quo. The political barrier is the tension and angst between a comfortable status quo for individual patients, providers, and institutions and the promise that the Triple Aim offers as benefit for the collective. I want to explore the most important part of that last quote, “ The remaining barriers are not technical they are political”. The pain of the transition state-the disruption of institutions, forms, habits, beliefs, and income streams in the status quo-is what denies us, so far, the enormous gains on components of the Triple Aim that integrated care could offer. The superiority of the possible end state is no longer scientifically debatable. Rational common interests and rational individual interests are in conflict.įrom this understanding it was possible for them to describe the barriers that existed in 2008 and that persist today, almost eight years later. From the viewpoint of the United States as a whole, it is essential yet from the viewpoint of individual actors responding to current market forces, pursuing the three aims at once is not in their immediate self-interest…. Thus, we face a paradox with respect to pursuit of the Triple Aim. They asserted that it was rare to find organizations that were attempting to improve all three legs of the objective and related this to the conflict between the rational interests of individual institutions and the overall system of care in terms that were reminiscent of Garrett Harden’s concept of the “tragedy of the commons”.įor most, only one, or possibly two, of the dimensions is strategic, but not all three. We suggest that three inescapable design constraints underlie effective accomplishment of the Triple Aim: (1) recognition of a population as the unit of concern, (2) externally supplied policy constraints (such as a total budget limit or the requirement that all subgroups be treated equitably), and (3) existence of an “integrator” able to focus and coordinate services to help the population on all three dimensions at once. They outlined necessary strategic considerations:
In the aggregate, we call those goals the “Triple Aim”: improving the individual experience of care improving the health of populations and reducing the per capita costs of care for populations. …the United States will not achieve high-value health care unless improvement initiatives pursue a broader system of linked goals.
#TRIPLE AIM HEALTHCARE FREE#
Ģ) Customized care based on patient’s needs and values.Ĥ) Shared knowledge and the free flow of information.ġ0) Cooperation among clinicians. Less noticed, but of equal or more importance was a template that offered vast system variation as long as certain systems properties were present.ġ) Care based on continuous healing relationships.
Their solution was an extension of the recommendations that had emanated from Crossing the Quality Chasm (2001) where quality healthcare was defined in terms of a user experience that was patient centered, safe, timely, efficient, effective, and most of all equitable. The authors diagnosed why the system was flawed, frequently failed its customers and was so expensive. Their assertion remains a triple surprise for me. In “The Triple Aim: Care, Health, And Costs” Berwick, Nolan and Whittington describe American healthcare as the most fragmented, most expensive and least effective care delivery system among all of the advanced economies of the world, and they identify the barriers to improvement.
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