Our understanding of health outcomes is based on the Quadruple Aim of Affordable Healthcare

The Quadruple Aim is an extension of the Triple Aim of Affordable Healthcare. Developed by the Institute for Healthcare Improvement (IHI) in 2008, the Triple Aim was an initial attempt to formally recognise the need to balance potentially competing objectives.

The three different aims are:

  • improving the health of the population
  • improving the individual experience of care, and
  • reducing the per-capita cost of care.


The fourth aim, caring for the carer, was proposed after a decade of experience in implementing, testing and studying the Triple Aim in numerous
countries, including Australia.


In addition to highlighting the need for a fourth aim, the 10-year period for observation and analysis has shown that the ‘guiding principles’ inherent in this approach result in improved outcomes across each of the aims simultaneously.


The Metrics for Health Outcomes are in development:


One of the challenges noted in the literature covering the Quadruple Aim is the importance of using appropriate metrics to measure the different aims that together constitute health outcomes. The NCC has identified an appropriate suite of metrics that covers each of the four aims.

In many cases the data required to measure these metrics is not yet available.

The intention is for the NCC to encapsulate the need for this data in the next tranche of agreements and contracts with all service providers.

3.1  Quantify the gap to be bridged: Understand the difference between the delivered and desired level of performance.
The Quadruple Aim of Affordable Healthcare has been shown through research to be a key enabler of improved health outcomes. Inherent to the success of this approach is the founding principle of population specificity. That is, the approach must be applied on a population-by-population basis. This is because, different groups of people have different needs and therefore benefit from different interventions.
A foundational piece of work undertaken by the NCC has been the development of a means by which the health of the population can be measured. This approach starts with the Quadruple Aim and then cascades to individual measures. Using this framework and approach has enabled the NCC to quantify the state of health for the population, creating a baseline against which the success of co-commissioned interventions can be assessed.
An early challenge for decision-makers is determining the improvement in health outcomes
to be targeted. Specifically, the four dimensions of the Quadruple Aim must be addressed.
The difference between the Health Outcomes Forecast and that level set as the target is the ‘gap’ that is to be bridged.