The Quadruple Aim as a measure of successful healthcare systems
In 2008 Donald Berwick, Thomas Nolan, and John Whittington, faculty members of the Institute for Healthcare Improvement (IHI), undertook research to establish behaviours that would allow the delivery of high-value healthcare in the United States. Through this, they developed the idea of the Triple Aim of Healthcare which focused on three goals, namely; improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations. The idea being that these goals would become the measure of success to establish if a healthcare system was functioning optimally, and if needs be these would become the pillars to reform non-functional systems.
Thereafter, in 2014, building on the IHI’s work, Thomas Bodenheimer and Christine Sinsky proposed the idea of the Quadruple Aim which introduced the element of the wellbeing of the care team. This was after research showed, that there was significant burnout and dissatisfaction amongst care providers in the U.S (there is growing evidence this is a worldwide trend and applicable throughout the globe). And so, the triple aim became the quadruple aim and these goals are now seen as the guiding principles in achieving functional and effective healthcare systems.
User, User, User
So, with these goals in mind, there is still the issue of how to go about designing systems and solutions that allow organisations to meet the quadruple aim. Enter design thinking.
Design thinking is a human-centred problem-solving method that encourages creativity and is built on the elements of empathy, collective idea generation, rapid prototyping, and continuous testing to tackle complex challenges. Unlike traditional problem-solving methodologies that starts with a conclusion and tests solution to confirm the solution is the correct one, design thinking begins with curiosity and follows a process to figure out what ideas and solutions organisations should implement.
Design thinking distinguishes itself from traditional problem-solving methods by placing great emphasis on the user and understanding their experiences, before thinking up a solution. This rigour allows organisations to fully understand the problem and design products and services that actually meet a need. This ensures that the user will derive value from the solution and make the solution a successful one. And because design thinking promotes iterative testing and refining of ideas, user feedback is frequently sought and adjustments are made to the solution. This process ensures that the solution continuously delivers value as the market and user needs change.
Technology as a driver of healthcare transformation
In setting the agenda for the transformation of the South African healthcare system the former Health Minister notes in the recently updated Digital Health Strategy for South Africa 2019-2024, that the vision for a transformed healthcare system must be enabled by digital health. Notably the Digital Health Strategy document recognises that for healthcare reform to be successful, people must be at the centre. According to the Strategy document solutions must address the needs of those who need healthcare, those who can be assisted to maintain healthy living, the health workers who provide a wide spectrum of health services, and managers who need to make critical decisions to enhance the health system for effective service delivery.
Most certainly this user-centred view supports the application of design thinking principles when figuring out how technology will drive the government’s vision to provide a long and healthy life for all South Africans. Globally and at home, most healthcare systems and solutions were designed around the payment mechanism and this has led to many other inefficiencies. The healthcare industry faces dire challenges such as duplicated cost of care, missed appointments with care providers, duplicated and inaccurate patient information, missing treatment and clinical history and the list goes on…
Using a design thinking approach and placing the impacted users at the centre of the solution, technology can be the enabler in solving the many pain points and frustrations of healthcare users, thereby leading to a healthcare system that actually delivers value to all those interacting within the system. This approach would support the quadruple aims by providing innovation that could lead to improved patient satisfaction, better health outcomes, lower cost of care and improved wellbeing of the care team.
Transforming our healthcare system requires well thought through approaches that force the various stakeholders to rethink the problem in a curious and bold manner. It is clear that a design thinking approach can help us achieve the objective of making healthcare more accessible, affordable and effective.