Quadruple aim reflects the evolving goal of healthcare performance optimization from the historical three-pronged focus on patient experience enhancement, population health improvement, and lower healthcare cost to a four-pronged approach that includes additional focus on improvement of healthcare providers’ work life. Quadruple aim reflects the growing challenges to healthcare systems in improving health of the global population, while simultaneously reducing healthcare costs to improve accessibility and affordability. Formerly, healthcare systems across the globe adopted the United States Triple Aim organizational system for steering healthcare reforms for a cost-effective improvement of healthcare performance. Achievement of Triple Aim demands highly successful healthcare organizations driven by a committed and productive labor force. Nevertheless, the Triple Aim paradigm overlooks the key role played by workforce in transformation of healthcare. Quadruple Aim improves Triple Aim achievements by acknowledging the significance of nurses, doctors, and all other healthcare workers joy and job satisfaction in improvement of healthcare performance (Fitzpatrick, Bloore and Blake, 2019) . Quadruple Aim therefore adds a fourth aim to Triple Aim that focuses on improvement of the experience of healthcare practice. In particular, the fourth aim focuses on joy and satisfaction in healthcare work experience as the core of healthcare practice. Joy refers to the sense of fulfillment and success derived from meaningful labor (Stefanacci, 2018) . Nevertheless, the fourth aim does not measure happiness. Instead, the fourth aim emphasizes on a sense of meaning and satisfaction on the entire workforce for contribution in healthcare delivery.
Evidence-based practice informs decisions that impact quadruple goals of healthcare performance at organizational level. In particular, EBP is critical for achievement of the Quadruple Aim in healthcare. EBP refers to a holistic focus on patient values, clinical expertise and best research evidence in informing patient care decisions. EBP strategy enable nurse practitioners and all other healthcare practitioners to integrate findings from research into clinical practice. EBP helps in achievement of Quadruple Aim through improvement of population health results, patient experience and in reduction of healthcare costs as well as improvement of clinicians work life and wellbeing (Beckett and Melnyk, 2018) . In particular, EBP helps in reducing burn out among nurse practitioners. EBP further improves healthcare performance by emphasizing on safety and quality as healthcare outcomes priorities. Exploitation of the best evidence in making clinical decisions helps in optimization of clinical outcomes.
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Evidence-based practice targets improvement of both the patient’s outcomes and healthcare processes (Bosserman, 2016) . In particular, EBP practitioners focus on improvement of safety and quality in healthcare delivery. Furthermore, research confirms that nurse’s expresses support for EBP as well as training on EBP skills and knowledge. A staggering volume of literatures also confirms that EBP improves healthcare outcomes, bridge gap in geographical disparities in care and cuts healthcare costs. Furthermore, case studies shows EBP contribution to empowerment of clinicians and improvement of job satisfaction levels among healthcare workforce.
Success and sustainability of EBP in turn depends on its adoption by NPs and the entire workforce. Furthermore, local, federal and state regulations dictate adoption and implementation of EBP. Lack of a standard protocol for EBP implementation in healthcare systems also limits its application in realization of Quadruple Aim. Several historical barriers further impedes implementation of EBP. Among the historical barriers to EBP include layman’s expertise and knowledge in EBP among NPs and other healthcare experts. A care organization also lacks an EBP supportive culture due to misperception on the painstaking demands of EBP. Obsolete organizational policies and politics also impede EBP implementation. Inadequate tools and resources for healthcare providers’ especially budgetary allocations for EBP similarly limits chief nurse executives from adopting EBP in their Quadruple Aim decision-making process.
References
Beckett, C. D., & Melnyk, B. M. (2018). Evidence ‐ Based Practice Competencies and the New EBP ‐ C Credential: Keys to Achieving the Quadruple Aim in Health Care. Worldviews on Evidence-Based Nursing, 15 (6), 412-413.
Bosserman, L. (2016). Pathways, processes, team work: Paving the way for value-based care with the quadruple aim. The Journal of Community and Supportive Oncology, 14 (7), 287-290.
Fitzpatrick, B., Bloore, K., & Blake, N. (2019). Joy in Work and Reducing Nurse Burnout: From Triple Aim to Quadruple Aim. AACN Advanced Critical Care, 30 (2), 185-188.
Stefanacci, R. G. (2018). Taking Aim at Number Four in the Quadruple Aim—Our Team. Annals of Long-Term Care: Clinical Care and Aging, 26 (4), 12-14.
