Improving Healthcare Outcomes: Keep the Triple Aim in Mind

Improving Healthcare Outcomes:
Keep the Triple Aim in Mind ―Michael Barton

© 2014 Health Catalyst
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“Improve Outcomes”
Improving outcomes means at a
high level means improving the
health of patients and the patient
experience, while reducing costs.
Once organizations get into the
work of measuring outcomes—
the question of what constitutes
an improvement becomes much
more complex.
The truth is that not all outcomes
are created equal.

The Triple Aim:
Improving Healthcare Outcomes
Everyone in healthcare is probably
familiar with the Institute for Healthcare
Improvement’s Triple Aim:
Triple Aim
• Improving the individual experience of care
• Improving the health of populations
• Reducing the per capita cost of care for populations
Better Value
SOURCE: IHI TRIPLE AIM

The Triple Aim:
The Triple Aim at its most basic
represents a framework for improving
healthcare delivery outcomes.
When healthcare organizations go
about improving outcomes they will
want to consider all three dimensions
of the Triple Aim.
It’s an ambitious framework that
requires a high degree of system
change to attain.

The Triple Aim:
Consider this example:
An organization might initially cut
costs by decreasing length of stay
(LOS), but this “improvement” isn’t
as meaningful without considering
how decreasing LOS affects clinical
outcomes and patient experience.
• Did the quick discharge increase the
incidence of readmission, risking
patient safety and increasing costs?
• Did it increase or decrease patient
satisfaction?

The Triple Aim:
Achieving the appropriate
balance among the three
dimensions is the central idea
driving the Triple Aim and
critical to achieving real, long-
term change in healthcare
delivery outcomes.

The Triple Aim: Litmus Test
The Triple Aim provides a valuable
litmus test for assessing whether
an organization’s efforts to improve
outcomes have the right focus by
answering these questions:
• Does this outcome pass muster
as something relevant to the
patient populations we serve?
• Is it the most impactful initiative
in terms of improved healthcare
delivery and health outcomes?
• Does it encompass multiple
dimensions of the Triple Aim?

The Triple Aim: Litmus Test
It’s also a good way to test the
maturity of the organization.
• Is the organization ready to take
on rapid improvement cycles to
deliver meaningful outcomes?
• Are the outcomes helping to
improve healthcare delivery?
• Can they automate
measurement of all three
dimensions of the Triple Aim?

Visibility
Using the Triple Aim framework
helps put outcomes in a more
meaningful context, demonstrating
improvement that is visible,
meaningful, and relevant.
Senior leaders share this detail
with their board of directors.
It is critical this information be
widely disseminated to ensure
organizational alignment regarding
priorities and incentives.

Visibility
Communicating successful
outcomes improvements to the
entire organization is crucial.
Visibility to the results of an
improvement initiative gives
leaders a level of understanding as
to the engagement and support of
the strategy by all team members.
It also allows leaders to identify the
capabilities of the organization.

Visibility
Not every outcome will fulfill all
dimensions of the Triple Aim,
however developing the capability
to relate to Triple Aim is important
and worthy.
As you investigate your readiness
to improve outcomes, ask this:
• Is your organization capable, on a
regular basis, of approaching
outcome improvement from a
Triple Aim perspective?

Start SMART: Approaching
Improvement Measures Effectively
Tackling the Triple Aim successfully
requires defining improvement
measurements before implementing
improvement initiatives.
Improvement measures can be
described in three main categories:
• Outcomes
• Process
• Balance

Start SMART: Approaching
Improvement Measures Effectively
Regardless of the type of measure,
using the SMART acronym is helpful
to ensure that goals and aims state
how you will measure success.
Caution: While regulatory measures
like those from the CMS or The
Joint Commission are necessary,
and often based on best practices,
focusing solely on these measures
won’t drive necessary care
improvement across the
organization.

Outcome Measures
Outcome measures are the ultimate
arbiter of whether an organization is
achieving high-level goals
supporting the Triple Aim.
For example, an outcome goal
might state that the organization will
decrease the mortality rate of sepsis
patients by 20% by a certain date.
While iterative improvements will
occur, the outcome measure –
reduced mortality – is the ultimate
goal of those improvements.

Outcome Measures
Outcome measures hold the
improvement team accountable,
setting the standard for whether
the team is meeting its goals.
They deliver important visibility to
the organization about the value of
the improvement team work.
The resulting transparency from
sharing the team’s progress
against these measures builds
momentum and support.

Outcome Measures
An outcome measure maintains the
focus of the improvement team and
prevents scope-creep. It’s the
guiding star of the project.
When creative people gather to
solve problems, it’s common to
hear things like:
The outcome measure lets the
group determine whether the idea
furthers goal achievement.
Wouldn’t it be cool if we tried this?”

Process Aim and Measures
Although outcome measures show
improvement toward the high-level
goals of the organization, they don’t
define how to achieve those goals.
That’s where process aims and
measures come in.
Aim statements specify targets for
measureable process improve-
ments that ultimately contribute to
achievement of outcome goals.

For example, an aim statement to
decrease the time it takes to
recognize sepsis in the emergency
department and to initiate
evidence-based interventions like
the 3-hour bundle.
Associated measures may be:
Time from ED arrival to sepsis recognition.
Time from sepsis recognition to initiation of
the 3-hour bundle.

Other aim statements may specify
a target for improving overall
compliance to the sepsis 3-hour
bundle, or to improvement in
individual elements of the bundle,
like timely antibiotic administration.
Associated measures may be:
“X” percent compliance to all the sepsis 3-
hour bundle.
Time from sepsis recognition to antibiotic
administration.
See more: Learn to create effective aim statements here.

Process aims and measures
empower clinicians to take action
on the data and improve care.
An outcome goal to improve sepsis
mortality by 20% fails to provide
detail for how clinicians contribute
to achieving the goal.
Engaging frontline employees in
process aims and measures allows
them to understand how care
processes contribute to outcome
evaluation and improvement.

Clinicians see how improving the
timeliness of antibiotic administra-
tion contributes to achieving the
outcome of improved mortality.
The measure provides direction
and instruction for the clinician.
It is an early indicator of whether
they are meeting the objectives of
the improvement initiative.
Over time, the outcome will reflect
these improvements in the process.

Balance Measures
The Triple Aim serves as the ultimate
framework for thinking of balance measures.
An improvement in one of the dimensions of
the Triple Aim should not result in a negative
outcome for the other two.
Achieving balance is key as organizations
pursue these ambitious and very
important improvement objectives.

A Sepsis Example from
Thibodaux Regional Medical Center
As Thibodaux Regional entered the shared-risk market, it was
critical that senior leaders and physicians identify and
prioritize improvement opportunities—together.
Employing an enterprise data
warehouse and analyzing key
process analytics, the cross-
functional team identified sepsis
as an area for improvement.
Keeping the Triple Aim at the
forefront, Thibodaux Regional
set goals to reduce overall
sepsis mortality by 25%, reduce
costs by 20%, and maintain a
99% patient satisfaction rate.

To improve patient outcomes, the
team established early recognition
protocols in the ED
They developed an algorithm for
early identification of at-risk patients,
and initiated three- and six-hour
sepsis bundle protocols.
They created aim statements and
process measures around these
changes, and physicians were held
accountable for complying with the
new protocols.

At the start of the improvement
initiative, Thibodaux Regional’s
sepsis mortality rate was already
outperforming the national sepsis
mortality rate of 14 to 18%.
The Thibodaux Regional team has
decreased their sepsis mortality rate
to half of the U.S. national average
while reducing variable cost per
sepsis case by 7.3% and increasing
patient satisfaction for sepsis
patients to the 93rd percentile.

Thibodaux Regional represents the
positive returns hospitals can
achieve as they strive to improve
outcomes for quality, patient
satisfaction, and cost.
Keeping the Triple Aim in mind
when creating a strategy for
optimizing outcomes empowered
the organization to confidently and
successfully pursue care
improvement objectives.

More about this topic
Prospective Analytics: The Next Thing in Healthcare Analytics
Anne Marie Bickmore, Engagement Executive, VP
Patient Engagement And Outcomes Improvement from the Patient’s Perspective
Steve Catmull
Outcomes Improvement: What You Get When You Mix Good Data with Physician Engagement
Paul Horstmeier, Chief Operating Officer
Improving Outcomes for Sepsis Patients: 3 Key Solutions Proven to Help
Delivering Excellence: How Stanford Health Care Uses Analytics to Improve Outcomes
Link to original article for a more in-depth discussion.
Improving Healthcare Outcomes: Keep the Triple Aim in Mind

For more information:

Michael Barton joined Health Catalyst as an Engagement Executive Vice
President in January 2013. He completed his training at the University of Utah
Health Sciences Center. Upon graduation in 1994, he was employed with the
Pharmacoepidemiology Team, a multidisciplinary team of epidemiologists,
infection control practitioners, quality control specialists, pharmacists, and
healthcare IT specialists at the University of Utah. After four years, Michael
moved his clinical practice to the Shock-Trauma ICU at LDS Hospital.
Here, he had the opportunity to apply his infectious disease and critical care knowledge. After eight
years of clinical practice in conjunction with five years of IT industry consulting experience, Michael
joined HIT startup TheraDoc, Inc. as a consultant in 2000 and full-time in 2001. Michael spent 12
years with TheraDoc, where he served in various roles. The last 5 years Michael served on the
senior leadership team as SVP, Knowledge and Product Development where Michael oversaw the
Knowledge Management, Product Management, Engineering, and Quality teams. For Michael,
joining Health Catalyst means continuing to pursue his passion of improving the quality and safety
of patient care through applied healthcare IT solutions.
Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com

Improving Healthcare Outcomes: Keep the Triple Aim in Mind

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