NURS 6052 Week 1 Discussion: Nursing Research and EBP Assignment

Evidence-Based Practice and the Quadruple Aim

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.

  • Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
  • Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

  • Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

  • Patient experience
  • Population health
  • Costs
  • Work life of healthcare providers

Learning Resources

Note: To access this module’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

  • Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
  • Chapter 1, “Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry” (pp. 7–32)
  • Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707–708. doi:10.3928/01484834-20171120-01

Note: You will access this article from the Walden Library databases.

  • Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–175. doi:10.1111/wvn.12126

Note: You will access this article from the Walden Library databases.

  • Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340–348. doi:10.1111/wvn.12171

Note: You will access this article from the Walden Library databases.

  • Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51–53. doi:10.1097/01.NAJ.0000366056.06605.d2

Sample Paper: Connection between EBP and Triple/Quadruple Aim

Patient outcomes have become a critical component in the transformation of healthcare. Triple/quadruple Aim is an excellent example of how healthcare organizations improve their services by turning to evidence-based practice-EBP. In the past, healthcare organizations concentrated their efforts on improving the health of populations, enhancing patient experience, and lowering the cost of healthcare. In recent years, the approach has added a critical component of improving the work-life of the staff of healthcare organizations.

The Triple Aim approach introduced in 2008 by Donald Berwick and his colleagues was a critical step in enhancing patient outcomes. However, the overarching goals by Berwick and the team ignored a critical component in providing enhanced and quality care to the patients, namely the work-life of healthcare workers (Fitzpatrick et al., 2019). 

The quadruple Aim has since enjoined this critical factor to the other three in the Triple Aim. The work-life of healthcare staff directly impacts the quality of care given to patients. Positive job satisfaction and cohesion lead to positive outcomes in patient care while job dissatisfaction by healthcare workers results in poor quality of service offered to patients/customers.

Sikka, Leape, and Morath (2015) identified job satisfaction as the fourth most critical goal in implementing evidence-based practice. The study by Sikka et al. (2015) revealed that EBP among healthcare practitioners is a primary predictor of job satisfaction. Transforming the healthcare sector and the provision of quality care to patients cannot happen until issues surrounding the work-life of healthcare workers are adequately addressed (p. 608). 

Among the critical factors concerning the work-life of healthcare providers is job satisfaction. Indeed, a national survey done in the United States in 2017 revealed that over 1 million registered nurses nationwide quit their jobs because of stress and burnout (Kapu et al., 2019). The level of job satisfaction and motivation of the healthcare workers affect patient outcomes and the implementation of EBP.

Additionally, EBP enhances patient experience by focusing on such critical aspects as cost, quality of service delivered and ease of access to care. Patient experience is a critical parameter in the healthcare industry because it measures the level of satisfaction by patients with the services of healthcare providers. Patient experience is critical because it affects not just the health of patience, but also the profitability of healthcare organizations (Sikka, 2015). 

Cost has been identified by health experts as one of the impediments to access to health. Many people in the country suffer silently because they cannot afford to pay for their healthcare. The Quadruple Aim introduces several measures that can be used by patients to afford healthcare. Excellent examples of methods of affordable care advocated for by this approach is a system of universal healthcare coverage for everyone through the affordable health insurance schemes.

Evidently, the Quadruple Aim seeks to enhance the quality of care given to patients by prioritizing the work-life of healthcare practitioners. The transformation of the healthcare sector cannot be implemented without taking care of the welfare and the work-life of healthcare workers. Attempts to implement the triple Aim have previously failed due to the omission of the improvement of the work-life of nursing practitioners. Quadruple Aim supports EBP because it addresses all critical factors necessary for the provision of quality healthcare, which includes taking care of the welfare of healthcare workers.


  • Fitzpatrick, B., Bloore, K., & Blake, N. (2019). Joy in Work and Reducing Nurse Burnout: From Triple Aim to Quadruple Aim. AACN Advanced Critical Care, 30(2), 185-188. doi: 10.4037/aacnacc2019833
  • Kapu, A., Borg Card, E., Jackson, H., Kleinpell, R., Kendall, J., & Lupear, B. K., LeBar, K., Dietrich, M. S., Araya, W. A., Delle, J., Payne, K., Ford, J., & Dubree, M. (2019). Assessing and addressing practitioner burnout. Journal of the American Association of Nurse Practitioners, 33(1), 38-48. doi:10.1097/jxx.0000000000000324
  • Sikka, R., Morath, J., & Leape, L. (2015). The Quadruple Aim: care, health, cost and meaning in work. BMJ Quality & Safety, 24(10), 608-610. doi:10.1136/bmjqs-2015-004160