The Triple Aim can be Elusive

[Anonymous]

Over the years I, like others, pushed to achieve success with the triple aim. Then I encountered a process improvement practitioner who said the problem is that we approach the triple aim as a destination, a single point of reference where quality is high, costs are low, and service is unmatched. But therein lies the problem as one of the three is always inversely related. He challenged me to prove him wrong and said just try to improve all three at the same time and see what happens. Well after a few years I discussed this with him and in my experience and my research I could not improve all three at the same time.

The realization settled in as I understood that the triple aim is not a destination but a range. If you improve quality and costs, your service lowers. If you improve quality and service, your costs went up. Rather than consider the triple aim a total fallacy I researched the topic and found that if you graph this out where the horizontal axis is freedom from defects and the vertical axis is cost, then there is a middle area where all three can comfortably meet depending on how you are with service. Too little quality, you have scrap or services that do not meet customer requirements. Too much quality, yes that is a thing, and you have outlandish costs on quality elements the customer neither wants or needs.

Recently I have contemplated there must be a maximum achievable equilibrium, similar to a price point in business. But will that range of acceptable cost, quality, and service be enough? Will it get us to true patient safety and quality of care? Will it produce the desired revenues and profits organizations want or need to stay in business? Will healthcare realize service excellence? Personally I feel the answer is no because of the why. Why are governmental programs in direct conflict with achieving success where value based purchasing is budget neutral? If the 50th percentile of quality rests at 98.7% in a category, then an organization scoring 98.6% lost money yet any customer would probably argue 98.6% in quality is pretty good. So for me the game is about operating within the appropriate range but personally I feel high reliability requires much more than settling for where the range will take us. Anyone else feel different? The same? Let me know because I love these types of discussions.

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