Evidence-Based Practice And The Quadruple Aim

Evidence-Based Practice and the Quadruple Aim

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.

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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.

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. 

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

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 1, “Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry” (pp. 7–32)

Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707–708. doi:10.3928/01484834-20171120-01

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. doi:10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340–348. doi:10.1111/wvn.12171

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51–53. doi:10.1097/01.NAJ.0000366056.06605.d2. Retrieved from http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/NCNJ/A/NCNJ_165_516_2010_08_23_DGSODKGNM_1651_SDC516.pdf

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5–15. doi:10.1111/wvn.12021. Retrieved from https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/wvn.12021

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24, 608–610. doi:10.1136/bmjqs-2015-004160. Retrieved from https://qualitysafety.bmj.com/content/qhc/24/10/608.full.pdf

  • Patient experience
  • Population health
  • Costs 
  • Work life of healthcare providers

Evidence-Based Practice and the Quadruple Aim

Evidence-Based Practice
Evidence-Based Practice


Evidence-Based Practice and the Quadruple Aim

Evidence-based practice (EBP) and the quadruple aim both help to create improved healthcare equality, improve patient outcomes, reduce hospital cost, and improve the work life of clinicians (Malnyk, Gallagher-Ford, & Fineout-Overholt, 2016). EBP is a problem-solving approach that provides the best evidence to inform nursing practice and help to provide the best patient outcomes (Melnyk & Fine-Overhold, 2018). The quadruple aim consists of improving each patient’s experience of care, improving health population, reducing the per capita cost of healthcare, and improving the lives of the healthcare workforce (Sikka, Morath, & Leape, 2015). It is essential that both the quadruple aim and EBP are equally implemented to achieve the desired outcomes due to the fact that one cannot be fully achieved without the other.

EBP can help reach the Quadruple Aim in all four measures, which are patient experience, population health, cost, and work life of healthcare providers. The patient experience is enhanced when utilizing EBP into care delivery and decisions made by healthcare providers. For example, in my healthcare organization, we perform hourly rounding on every patient, which is backed by EBP to improve the patient experience. Integrating the best available evidence to support decisions in order to strengthen the patient’s quality and safety of the patient experience is optimized by EBP (Lavenberg et al., 2019).

Population health is driven by EBP in order to address population characteristics, needs, values, and preferences (Jacobs, Jones, Gabella, Springs, & Brownson, 2012). For example, heart failure, diabetes, and obesity have become an epidemic. Understanding and using EBP to approach new ways in helping the population who suffer from these comorbidities will help reach the Quadruple Aim. Implementing EBP approach in population health goals to develop easily accessible and time-efficient tools to improve population health will serve as a driver for success (Jacobs et al., 2012). Addressing the population health issues will ultimately affect cost measures by reducing hospitalizations, fewer test, and fewer doctor visits. EBP is proven to improve patient outcomes, which in turn, results in cost-effective care (Hrabe, 2017). Therefore, EBP helps to reach costs measures needed to reach the Quadruple Aim.

The fourth goal of the Quadruple Aim is essential to be able to meet the first three measures. The work life of healthcare providers can have a positive or negative impact on patient outcomes. Healthcare providers are experiencing burnout, increased stress, and depression, all of which are associated with decreased patient satisfaction, poor health outcomes, and increased cost (Bodenheimer & Sinsky, 2014). For example, when nurses or doctors are stressed or have a lack of empathy, they are less likely to give their full attention to the patient. This can lead to a lack of focus which can decrease patient satisfaction, increase errors, and make poor judgments. Utilizing EBP to develop interventions to ease burnout and facilitate better processes to reduce the workload will help to improve the work life of healthcare providers. Also, EBP can empower healthcare providers, which can result in higher job satisfaction, improves enjoyment and engagement with their patients (Bodenheimer & Sinsky, 2014).

In conclusion, it is essential that healthcare organizations start making EBP a priority in order to achieve the Quadruple Aim. Reaching the fourth aim is a foundational element for all other goals to be achieved as the healthcare workforce is the backbone of an effective healthcare system (Sikka et al., 2015).


Bodenheimer, T., & Sinsky, C., (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annual Family Medicine12(6), 573-576. https://doi.org/10.1370/afm.1713

Hrabe, D. P., (2017). Committing to a culture of interprofessional evidence-based practice. Worldviews on Evidence-Based Nursing14(5), 341-342. https://doi.org/10.1111/wvn.12251

Jacobs, J. A., Jones, E., Gabella, B. A., Springs, B., & Brownson, R. C. (2012). Tools for implementing an evidence-based approach in public health practice. Preventing Chronic Disease9(1). https://doi.org/10.5888/pcd9.110324

Lavenberg, J. G., Cacchione, P. Z., Jayakumar, K. L., Leas, B. F., Mitchell, M. D., Mull, N. K., & Umscheid, C. A. (2019). Impact of a hospital evidence-based center on nursing policy and practice. Worldviews on Evidence-Based Nursing16(1). https://doi.org/10.1111/wvn.12346

Malnyk, B. M., Gallagher-Ford, L., & Fineout-Overholt, E. (2016). Improving healthcare quality, patient outcomes, and costs with evidence-based practice. Reflections on Nursing Leadership43(3), 1-8. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=119422530&site=eds-live&scope=site

Melnyk, B. M., & Fine-Overhold, E. (2018). Making the case for evidence-based practice and cultivating a spirit of inquiry. In B. M. Melnyk & E. Fine-Overhold (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed., p. 7-32). Philadelphia, PA: Wolters Kluwer.

Sikka, R., Morath, J. M., & Leape, L. (2015). The quadruple aim: Care, health, cost, and meaning in work. BMJ Quality & Safety24(), 608-610. https://doi.org/10.1136/bmjqs-2015-004160

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