Book review: Pursuing the Triple Aim

The Triple Aim


Sometimes it is easier to grasp the possibility of big change when we’re confronted with the small stories, the ones that come from the individual or local levels. This idea is the basis of Pursuing the Triple Aim by Maureen Bisognano of the Institute of Healthcare Improvement (IHI) and author Charles Kenney. About improving the quality and affordability of health care in the United States, the following defines the book’s aim:

If the innovations we write about here were spread throughout the United States, they would almost certainly improve the quality and safety of health care by an order of magnitude.

The innovations explored in this book are the work of singular organisations “led by men and women of vision.” All but one are not-for-profit and all are models for change on a national level. They follow IHI’s Triple Aim, which is about providing safe and reliable care to the individual patient, improving the health of communities and populations and decreasing cost, and the authors’ intention is that their stories are practical inspiration for others to adopt their approaches and, in doing so, incrementally build the local into the national.

Below are some examples:

  • CareOregon, a Medicaid managed care plan which, through innovative partnerships with provider organisations and methods to reduce use of expensive forms of care, has reduced cost and improved quality of care for its mostly poverty stricken patients
  • Bellin, an integrated health care delivery system that improved its employees’ health scores and lowered employee health coverage over eight years, ultimately saving $13 million. Bellin then transferred its population health management strategies to hundreds of other companies
  • Dr. Anthony DiGioia’s Patient and Family Centred Care (PFCC) Methodology and Practice, designed around the imperative of patient-centred care. DiGioia’s method refocuses existing resources so that providers can do “more with less.” DiGioia’s patients receive high quality care that is more expedient, affordable, and satisfactory than the national average

Each chapter delves into the details and the stories behind the innovations. How did individuals and organisations confront obstacles? What inspired them to do what they did? How did they do it? What are the ingredients of change?

This book is well worth a read in its timeliness. As Donald Berwick states in a review of the book,

I have never seen, nor had I dared hope to see, an era in American health care when transformational improvement is more possible than this moment. We have the templates. If you doubt it, I urge you to read this book.