The Relationship Between the Quadruple Aim and Evidence-Based Practice

Two outside resources and 2-3 course specific resources are needed for this assignment
Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions. The Relationship Between the Quadruple Aim and Evidence-Based Practice

To Prepare:

Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.
To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

Patient experience
Population health
Work life of healthcare providers

The Relationship Between the Quadruple Aim and Evidence-Based Practice or EBP

The objectives or aims of population health improvement, affordability of healthcare services through the lowering of costs, and improvement of the patient experience are what constitute the so-called Triple Aim. According to Feeley (2017) and Sikka et al. (2015), these were conceived and advanced by the Institute for Healthcare Improvement or IHI.        Analysis of how these three aims interact and how healthcare workers make them a reality revealed later that achievement of the three aims would be very difficult if the physical and psychological wellness of the workers was not considered. As a result, a fourth aim was added which became known as the improvement of the wellbeing and the quality of work life of the healthcare employee. The lack of psychological safety at the workplace is one of the factors that would jeopardize the wellbeing and work life of a healthcare employee. This is because it would lead to stress, resentment, fear, uncertainty, burnout, and ultimately a high turnover intention among the employees. According to Crabtree et al. (2016) and Melnyk and Fineout-Overholt (2019), evidence-based practice or EBP is the clinical practice concerned only with the use of interventions and treatments that have a backing for efficacy from scholarly peer-reviewed and published literature. This backing is what is called evidence and is in different levels as per the hierarchy of evidence. It (EBP) has been referred to as best practice while its opposite is common practice. The purpose of this paper is to draw a nexus between EBP and the Quadruple Aim; as well as outline how the former can help in achieving the latter.


The Role of Evidence-Based Practice (EBP) in the Achievement of the Quadruple Aim

This can be demonstrated by looking at each of the four aims forming the Quadruple Aim as illustrated below:

Population Health

In order to guarantee population health, sound interventions with proven efficacy need to be used so that incidents such as readmissions and prolonged hospital stays are not witnessed. Social determinants of health like educational achievement and socioeconomic status affect the health of all population demographics but at varying levels (Powell, 2016). When citizens from these population demographics seek healthcare services, only EBP will help restore them to wellbeing the fastest and surest way possible.    The Relationship Between the Quadruple Aim and Evidence-Based Practice 

Healthcare Cost Lowering

By using only EBP when managing patients, the advanced practice nurse helps in making healthcare affordable. This is true in that EBP produces quicker recovery and shortens the length of hospital stay. The net effect of these is that the patient and family spend less on quality healthcare services.

Improving the Patient Experience

Patient experience of care can only be memorable if the care is effective and efficient as well as timely and patient-centered. The only type of practice that can ensure this is possible is EBP. For instance, EBP will ensure there are fewer readmissions and that patients stay for only a short time in the hospital. But it will also lower the rates of outcomes that represent low quality care such as patient falls, catheter-associated urinary tract infections (CAUTI), pressure ulcers, and central line associated blood stream infections or CLABSI amongst others. A satisfied patient is a brand ambassador.

Bettering the Work Life and Wellbeing of Healthcare Employees

The people who are instrumental in actualising the Triple Aim are the healthcare workers. It therefore goes without saying that making their lives better and looking after their wellbeing is the key to making the realisation of the Triple Aim a success. For this to happen there must be transformational leadership within the organization (Asiri et al., 2016). A transformational leader inspires, motivates, and encourages subordinates to achieve beyond expectations.


The Triple Aim was a noble idea from the IHI that had to be changed to the Quadruple Aim when a fourth aim was added. EBP is essential if the Quadruple Aim is to be achieved.


Asiri, S.A., Rohrer, W.W., Al-Surimi, K., Da’ar, O.O., & Ahmed, A. (2016). The association of leadership styles and empowerment with nurses’ organizational commitment in an acute health care setting: A cross-sectional study. BMC Nursing, 15(38), 1–10.

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.

Feeley, D. (2017, November 28). The triple aim or the quadruple aim? Four points to help set your strategy. Institute for Healthcare Improvement.

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4th ed. Wolters Kluwer.

Powell, D.L. (2016). Social determinants of health: Cultural competence is not enough. Creative Nursing, 24(1), 5-10.

Sikka, R., Morath, J.M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24(10), 608-610.

The Relationship Between the Quadruple Aim and Evidence-Based Practice


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