Many healthcare leaders will be familiar with the concept of the Triple Aim. To summarize, the Triple Aim is a framework developed by the Institute for Healthcare Improvement (www.ihi.org) that outlines an approach to optimizing health system performance.
The foundation of the Triple Aim is the belief (supported by evidence) that effective, sustainable healthcare and healthcare systems must pursue three dimensions simultaneously. These three dimensions include:
● The patient experience of care (including quality and satisfaction),
● The health outcomes produced, and
● The productivity of the system and the costs of healthcare.
The value of the Triple Aim approach is that it reflects the current reality for healthcare systems around the world – the struggle to effectively balance the need for an affordable or profitable healthcare system with a quality patient experience and the achievement of optimal health outcomes.
By keeping the three critical elements of the Triple Aim in their sights at all times, healthcare organizations are better positioned to:
(1) Make the fact that the three elements, and the balance between them, are key to the organization’s strategy and business model transparent to all,
(2) Effectively manage the inevitable tradeoff decisions required in all healthcare organizations,
(3) Be alerted when an over-emphasis on one element of the Triple Aim is having a negative impact on another element, and
(4) Determine what optimal “balance” between each of the three elements of the Triple Aim looks like for the individual organization at any given point in time.
The great thing about the Triple Aim concept is that it can be applied to the healthcare system broadly or at the enterprise level. With this in mind, individual healthcare organizations can apply the Triple Aim framework to their strategy and business model.
One of the best tools available for capturing both an organization’s strategy and business model is the strategy map. Since it is both a strategy formulation AND strategy execution tool, organizations can use a strategy map to design, communicate, and manage the successful execution of an organizational strategy that will produce Triple Aim-based results and outcomes.
Let’s take a high level look at how you can build the Triple Aim into a strategy map for your mission-oriented/publically funded healthcare organization or hospital. Leveraging the strategy map format typically used in these types of organizations, here is an example of what this strategy map is likely to include.
Recall that the top/stakeholder perspective of the strategy map is designed to address the question: “To achieve our mission and vision, deliver our stakeholder promise, and provide/create value, what do we need to do for/deliver to our stakeholders?”
The convenient thing about the Triple Aim is that it’s the foundation of a quality healthcare system AND delivering Triple Aim outcomes satisfies the primary needs and expectations of key stakeholder groups (delivering stakeholder value as a result). Patients, the community, citizens, and funders share an interest in providing individual patients (and their families) with a quality care experience and producing better individual and societal health outcomes - all in a way that gets the most out every funding dollar (allowing the system to delivery more for the same amount of money). As a result, three strategic objectives, each one focused on a specific element of the Triple Aim, can be sufficient for the stakeholder perspective of your strategy map. Of course, the actual strategic objectives on your healthcare organization’s strategy map will be customized to reflect your choices in applying the elements of the Triple Aim to create value for your stakeholders’ unique needs.
Once the objectives of the stakeholder perspective have been set, the remainder of your strategy map is defined to depict the value chain that supports the achievement of Triple Aim strategic objectives.
The strategic objectives in the internal process perspective answer the question: “To give our stakeholders what they want/expect and achieve our mission and vision, what processes must we focus on and excel at?” Our sample strategy map outlines the critical components and processes, in both the clinical and operational dimensions, typically required to support the achievement of Triple Aim objectives. While the strategy map for your healthcare organization may include some or all of these objectives and/or more, the key is to identify the short list of processes required to deliver your desired stakeholder objectives and outcomes. Taking this step helps you (1) identify which clinical and business processes your organization must have in place to achieve Triple Aim results, and (2) allows to measure and manage the performance of the business processes that ensure the delivery of stakeholder outcomes and value.
The organizational capabilities perspective of your strategy map answer the question: “To produce the stakeholder results we desire and to excel at our critical processes, (1) what kind of culture do we need, what skills must we help our people develop, and how do we want to work together; (2) what is the nature of our service and care delivery partnerships and relationships and how must we work with others across the continuum of care, and (3) what types of data/information, tools and technologies must we have access to and how must we use them?” These strategic objectives form a critical foundation for the upper portions of your organization’s strategy map – their specifics will be customized based on the choices you have made in the previous perspectives.
While the financial/resource management perspective of the strategy map supports the achievement of all the other strategic objectives on your strategy map, it plays a very important role in enabling the achievement of the productivity/financial performance element of the Triple Aim. Strategic objectives in this perspective answer the question: “To create and deliver value to our stakeholders and achieve our mission and vision, how must we use our financial and non-financial resources and ensure that we do it in the most optimal way?” Strategic objectives focused on resource utilization support optimized clinical and operational process performance and enable the achievement of the Triple Aim’s productivity outcomes. A focus on strong financial management produces desired financial performance results AND builds the confidence and trust of funders – an important stakeholder outcome for publically funded healthcare organizations.
Building the Triple Aim into your healthcare organization’s strategy and business model via the strategy map is an important step you can take to ensure that your organization will achieve the desired results for most healthcare organizations - high quality healthcare outcomes for individuals and the system, cost-effectively and sustainably over the long-term.
Leverage the sample strategy map provided here to create a strategy and business model for your healthcare organization that is crafted to respond to the unique needs and expectations of your various stakeholder groups. By building your healthcare organization’s strategy and business model around Triple Aim concepts, it will be well positioned to create and deliver the value stakeholders need from your organization, other healthcare institutions and the broader health system itself.