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What do we mean when we talk about the Triple Aim? A systematic review of evolving definitions and adaptations of the framework at the health system level

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  • Mery, Gustavo
  • Majumder, Shilpi
  • Brown, Adalsteinn
  • Dobrow, Mark J.

Abstract

Notwithstanding important contributions of the Triple Aim, uncritical enthusiasm regarding the implications of the framework may be leading to inconsistent use, particularly when applied at the health system level, which goes beyond the original positioning of the framework as a strategic organizing principle to guide improvement initiatives at the organizational or local community level. We systematically identified uses of the Triple Aim that extended beyond its original intention to focus on uses at the whole health system level, to assess convergence and divergence with the original definition. We also attempted to identify consistencies in the way the Triple Aim was adapted for different contexts and settings. Data sources were indexed databases, web search engines, and international experts. Forty-seven articles were included in the analysis. We found that the definition of the Triple Aim has been subject to important modifications when the framework is used to define goals for whole health care systems or globally. Despite widespread recognition of the name, what constitutes the Triple Aim framework varies. We identified the need to consider the inclusion of at least two additional aims of health care systems – the provider experience of care, and the desire to achieve health equity for populations.

Suggested Citation

  • Mery, Gustavo & Majumder, Shilpi & Brown, Adalsteinn & Dobrow, Mark J., 2017. "What do we mean when we talk about the Triple Aim? A systematic review of evolving definitions and adaptations of the framework at the health system level," Health Policy, Elsevier, vol. 121(6), pages 629-636.
    • Handle: RePEc:eee:hepoli:v:121:y:2017:i:6:p:629-636
    DOI: 10.1016/j.healthpol.2017.03.014
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    Citations

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    Cited by:

    1. Obucina, M. & Harris, N. & Fitzgerald, J.A. & 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, Elsevier, vol. 122(8), pages 900-907.
    2. M Obucina & N Harris & JA Fitzgerald & A Chai & K Radford & A Ross & L Carr & N Vecchio, 2018. "The Triple Aim framework in the context of primary healthcare: A systematic literature review," Discussion Papers in Economics economics:201804, Griffith University, Department of Accounting, Finance and Economics.
    3. Milena Vainieri & Guido Noto & Francesca Ferre & Laura C. Rosella, 2020. "A Performance Management System in Healthcare for All Seasons?," IJERPH, MDPI, vol. 17(15), pages 1-10, August.
    4. Schoemaker, Casper G. & van Loon, Jeanne & Achterberg, Peter W. & van den Berg, Matthijs & Harbers, Maartje M. & den Hertog, Frank R.J. & Hilderink, Henk & Kommer, Geertjan & Melse, Johan & van Oers, , 2019. "The Public Health Status and Foresight report 2014: Four normative perspectives on a healthier Netherlands in 2040," Health Policy, Elsevier, vol. 123(3), pages 252-259.
    5. Kokko, Petra, 2022. "Improving the value of healthcare systems using the Triple Aim framework: A systematic literature review," Health Policy, Elsevier, vol. 126(4), pages 302-309.
    6. Willemine Willems, 2021. "Countering the Tragedy of the Health Care Commons by Exnovation: Bringing Unexpected Problems and Solutions into View," Sustainability, MDPI, vol. 13(23), pages 1-19, November.

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