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The Quadruple Aim and the Australian healthcare system

To support the delivery of safe and quality-focused healthcare, the number of moving parts required to piece it all together is mind-boggling, yet daily, thousands of Australians benefit from comprehensive care. The Australian Government’s Department of Health states that “Australia’s health system is one of the best in the world” and although this is the case, there’s always room for improvement.

Reflecting on models of care applied to various health systems worldwide, it’s helpful to assess these approaches to identify the best elements for bettering Australia’s healthcare performance. This type of assessment provides us with an opportunity to identify strategies and learnings to ensure Australian consumers are provided with access to an adaptive, responsive, robust and effective healthcare system.

The Triple Aim Framework

One internationally renowned framework, developed in 2008 by Donald Berwick and colleagues is the healthcare Triple Aim. This framework was created to support the delivery of high-value care in the United States by focusing on three key elements:

1) Improving the individual experience of care

2) Improving populations’ health, and

3) Reducing the per capita cost of health.

The overarching goal of this framework aims to support the redevelopment of healthcare systems to meet health population needs better while remaining cost-effective.

As the adoption of the Triple Aim grew in popularity, Thomas Bodenheimer and Christine Sinsky identified that a key foundation was missing – the critical role healthcare workers play in the delivery and transformation of healthcare. Even before the added pressures of COVID-19, healthcare workers continued to rank as one of the highest professions suffering from burnout and stress.

With burnout comes decreased patient satisfaction, reduced health outcomes and increased costs. All of these aspects counteract the achievements of the Triple Aim. With this in mind, a fourth aim was added to the framework to create the more inclusive ‘Quadruple Aim’. Recognising the impact healthcare professionals have on the success of healthcare delivery, the fourth aim focuses on improving the work-life of healthcare providers, including clinicians and staff.

How to achieve the Quadruple Aim?Diagram outlining the quadruple aim framework

When considering the application of the Quadruple Aim across Australia’s healthcare system, there’s been a gradual adoption of the four key pillars. Yet it’s clear that there needs to be greater collaboration across the entire system to enable us to reach our full potential. Australia’s intentions in the pursuit of comprehensive and integrated healthcare sit in the right place, yet the strategies to support us in achieving this need to better align.

To support a well-planned and executed approach to bettering Australia’s healthcare, the Australian Government Department of Health has developed a draft Primary Care 10 Year Plan. This plan aligns with the benefits of the Quadruple Aim in improving the health of populations.

Implementing the Quadruple Aim

The Primary Health Reform Steering Group have used the Quadruple Aim as a lens to test the intellectual and structural framework of their recommendations in regards to the Primary Care 10 Year Plan, to evaluate measures and directions captured and to prioritise actions for reform. The recommendations were chosen because the Steering Group believe they (when taken in their entirety) deliver against the Quadruple Aim.

Although implementing the Quadruple Aim model will mean different things to different health services, the intertwining of this framework at a national level will better prepare Australia for long term sustainability and enhanced health outcomes. This is particularly important in our current environment as we continue to face the challenges associated with COVID-19 and an ageing population, and as we work to ‘close the gap’ for our Aboriginal and Torres Strait Islander peoples.

Several Primary Health Networks (PHNs) and Local Health Districts (LHDs) have publicly committed to embracing the Quadruple Aim approach to improve primary, secondary and tertiary healthcare within their region. The practical application of the Quadruple Aim by these groups aims to engage better and involve patients, the community, clinicians and staff to create a value-based approach to care. Although varied initiatives are being implemented, their strategies are driven by the need to improve population health and patient experience while reducing costs and bettering workforce satisfaction.

Further to the approaches being undertaken by these thought-leaders, the Australian Government’s Health Care Home’s model was implemented across several general practices and Aboriginal Community Controlled Health Services (ACCHOs) to better coordinate person-centric care for those with chronic and complex conditions. These initiatives further contribute to improved patient experience and increases in patient activation. Although these are only a few examples of application, elements of the Quadruple Aim are present across Australian health services in a myriad of formats.

The Quadruple Aim provides a fundamental focus for healthcare transformation to support equitable outcomes for Australians now and into the future. With the support of national reform, encompassing the Primary Care 10 Year Plan, continual evaluation and review, Australians can look forward to an improved patient care experience, better population health and care accessibility, backed by greater cost-efficiencies and the benefits associated with a happier and healthier workforce.

How can CFEP Surveys Assist with the implementation of the Quadruple Aim framework?

To assist health professionals to strengthen partnerships with patients suffering long term conditions and to support and motivate improved self-management, CFEP Surveys developed the Patient Partnership in Care (PPiC) Tool.

The CFEP Surveys Patient Partnership in Care (PPiC) Tool is a validated, evidence-based feedback tool developed initially to assess PROMs and PREMs in patients with chronic disease as part of the Co-Creating Health Project in the UK.

To find out more, contact a member of our team or visit our PPiC page.

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