The Triple Aim Initiative: Principles, Challenges, and Reflection


In 2008, the Institute for Healthcare Improvement (IHI) introduced the Triple Aim framework. Its primary goal is to improve three aspects of healthcare: the experience of care, the health of the population, and reducing per capita costs. Triple Aim was subsequently adopted as the National Strategy for Quality Improvements in Healthcare. Despite Joint Commission’s role in developing and financing the US’ healthcare, healthcare organizations have struggled with identifying what initiatives they must pursue. With the priorities being undecided, individual practices attempted to achieve results on at least one of the Triple Aim dimensions (Obucina et al., 2018). The author of the essay intends to study the experience of their predecessors as it is vital to know and then take it into consideration whilst planning their own programs.

As the author studies Health and Medicine with their future lying in healthcare, they will have to work with the Triple Aim framework. Despite it being the future of healthcare, any planning on this matter needs to predict future difficulties with its realization in practice known from other organizations’ experience. Each of the three dimensions has caused significant problems in its realization, which includes lack of available data, new programs and measures being unreliable etc.

The Practical Realization of the Triple Aim Framework

The measures taking care of the health of population aspect included indicators on disease-specific outcomes and chronic conditions, which include mortality, cancer screening, immunization, smoking, and alcohol consumption. These indicators are usually collected via a monthly questionnaire, such as the one filled in by patients for 6 months to collect data on proton pump inhibitors (Lehky Hagen et al., 2019). As for the per capita costs, they are the most difficult to obtain data on. Such limitations were caused by patients attending medical examinations and getting medical care in different practices (Obucina et al., 2018). Therefore, the first specified attempts to follow the population’s health and the per capita costs dimensions have faced a lack of data and are dedicated to obtaining it.

The aforementioned collecting of data is deeply connected to evaluating the experiences of care. Surveys are a standard way of collecting in-house feedback on the patients’ satisfaction. Patients have been known to respond positively to electronic health record (EHR). Whenever a patient visits the hospital for prophylaxis, examination, or hospitalization, the EHR helps the medical staff by providing their understanding (Gesko et al., 2020). This is done by a summary that lists “the patient’s photograph, demographics and vitals, health directives, identification of their care team, recent and upcoming visits, preventive health needs” (Gesko et al., 2020, p. 111). It is predicted that in future, the EHR will help not just with the experience, but with population’s health and costs (Gesko et al., 2020). However, patients are not the only ones who partake in care: pharmacists and doctors do as well, and their experiences are analyzed via questionnaires, too (Lehky Hagen et al., 2019). Thus, the dimension of the experiences of care turns out to be the tool to overcome other dimensions’ obstacles.

Addressing the Complications

Thus, organizations face difficulties in their pursuit of Triple Aim principles. As they have to pursue three dimensions at once, they need to plan strategically and find the right balance between each of them. The key problem for these organizations is the data availability. The local contexts should be taken into consideration as well, as different organizations have difficulties at finding partners, communication, have no time, resources, or ability to improve or access data. The healthcare currently faces global problems, such as decline of primary care, burnout, and unmeaningful work. The latter is the reason the aforementioned EHR faces criticism, as it includes “pop-ups intruding into a clinical encounter” (Fojtik, 2021, p. 261). Obucina et al. (2018) argue that a single, overarching governance can unite the scattered organizations and enforce a program that everyone will follow. This can potentially make the healthcare system use the Triple Aim framework and conduct global comparisons.

The author of the essay, when positioned as an administrator of a high rank, will attempt to learn from other organizations’ experience. Strategic planning will ensure that each dimension is attended to with a thoroughly developed plan; local problems will be taken into consideration. As for the contradictory EHR program, it will be used throughout the institution, but it will have to be reworked not to interrupt clinical encounters. First, monthly questionnaires will be employed to collect the data on local specificity. Though it might contradict the main principle of the Triple Aim framework with every dimension being taken care of simultaneously, without the data the experiences of care provide, other dimensions cannot function. The author’s organization will cooperate with other institutions to develop unified methods of following the Triple Aim framework. Thus, the first step of the organization is to obtain the necessary data and only then to apply it to practice.

One of the measures successfully working under the Triple Aim framework is the Hospital Readmission Reduction Program (HRRP). Its purpose is to reduce excessive hospital readmissions by utilizing the 30-day hospital readmission rate. Ayabakan et al. state that “the impact of HRRP on the Triple Aim goals reveals significant improvements across all 3 dimensions of patient care delivery—quality, cost, and patient experience” (2021, p. 7). The author of the essay will adopt this program but, as a precautionary measure, will only use it on certain patients without life-threatening conditions to assess its usefulness.

The Medical Errors

When it comes to day-to-day work at a medical institution, the Joint Commission standards will be followed. Furthermore, special attention will be paid to medical errors of the nursing staff. They naturally influence health of population and the experience of care, as well as indirectly affecting the per capita costs because of the need to pay insurance or even go to court. As a director or an administrator of a nursing care unit, the author of the essay will ensure that all nurses, pharmacists, and physicians accept that the issues and mistakes are inevitable. Thus, they will not panic in non-standard situations nor attempt to cover-up their more critical mistakes. Communication between colleagues and error reporting are the key to deal with such situations. Colleagues offer their co-workers advice so that they do not repeat their mistakes in the future, while reports allow the staff to address the errors in a timely manner. Therefore, the medical unit under the author of the essay’s administration will have a healthy and friendly working ethic.

However, some of the nursing mistakes are not immediate, being caused by a lack of prior training. For example, illegal drugs might be brought to patients instead of prescribed ones. To prevent this, safety measures need to be undertaken, such as double- and triple-checks of drugs at patients’ disposal, especially the ones in syringes or cups. Any dangerous drugs the medical institution already possesses will be placed to safe areas under the author of the essay’s personal supervision. The staff needs to be instructed to report any deviations from the normal test results, as well as to pay special attention to tube placement for the most severe cases. Burnout needs to be taken care of as well; therefore, shift duration needs to be shortened in case the nurses tire. Thus, the most dangerous aspects of the nursing care will be under a strict and multi-level control, which will naturally work towards under the principles of the Triple Aim framework.


Thus, the analysis of the predecessors’ experience at following the Triple Aim framework has allowed the author to plan the necessary precautions. The framework, despite its best intentions and acclaim, has turned out to be difficult to realize. The reasons and aspects of this difficulty have to be taken into consideration before any strategic planning can be done. Some known measures such as the EHR or the HRRP really or reportedly follow the Triple Aim framework. However, the present situation in different organizations shows that they have to pay attention to the experiences of care dimension first, as they need to collect data to plan their programs in other dimensions.

The author of the essay’s own program is a careful one, utilizing all the necessary precautions to escape the mistakes made by the predecessors. While it can be argued that the Triple Aim framework has been developed more than ten years ago, the practice has shown that many medical care organizations are still unprepared to fully follow it. The program focuses on small-scale problems such as medical errors, while newly developed measures such as the EHR are tested in a limited scope. Another vital matter is that to address the Triple Aim framework fully, it is necessary to cooperate with other institutions, including absorbing other private medical care institutions. The author of the essay is even willing to offer their services and experience with the framework to a new governance should their own institution be absorbed by a private enterprise or the state.


Ayabakan, S., Bardhan, I., & Zheng, Z. E. (2021). Triple Aim and the Hospital Readmission Reduction Program. Health Services Research and Managerial Epidemiology, 8, 233339282199370. Web.

Fojtik J. E. (2021). The Three Confounding Elements of the Triple Aim. WMJ : official publication of the State Medical Society of Wisconsin, 120(4), 260–261.

Gesko, D. S., Worley, D., & Rindal, B. D. (2020). Creating systems aligned with the triple‐aim and value‐based care. Journal of Public Health Dentistry, 80(S2). Web.

Lehky Hagen, M., Julen, R., Buchs, P. A., Kaufmann, A. L., Gaspoz, J. M., & Verloo, H. (2019). Using a Triple Aim Approach to Implement “Less-is-More Together” and Smarter Medicine Strategies in an Interprofessional Outpatient Setting: Protocol for an Observational Study. JMIR Research Protocols, 8(7), e13896. Web.

Obucina, M., Harris, N., Fitzgerald, J., Chai, A., Radford, K., Ross, A., Carr, L., & Vecchio, N. (2018). The application of triple aim framework in the context of primary healthcare: A systematic literature review. Health Policy, 122(8), 900–907. Web.

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