. NURS 5052/NURS 6052/NURS 6052N/NRSE 6052C/NURS 6052C/NURS 5052C/NURS 6052A/NRSE 6052A: Essentials of Evidence-Based Practice

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Quadruple Aim

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Introduction

Evidence-based practice is one of the best strategies that are applied by healthcare organizations to enhance their quality and safety of healthcare, their health re- sults, and reduce cost and geographic variation in care. The EBP achieves the Triple Aim in healthcare, which are improving patient care experience, improving health population, and lowering the per capita cost of healthcare. But currently, the triple Aim has been enhanced to the Quadruple Aim after the addition of the fourth ob- jective of enhancing the work-life to reduce burnout in healthcare providers. Since EBP is found to encourage healthcare providers, thus resulting in better job

satisfaction, it can also assist the healthcare system in achieving the Quadruple Aim. This article is going to focus on how the EBP can affect or not affect the Quadru- ple Aim, the impact EBP may have on factors affecting the Quadruple Aim features, and the relationship between EBP and Quadruple Aim. How EBP may affect or not affect the Quadruple Aim

In 2008 Donald Berwick and his colleagues defined four broad objectives of Quadruple Aim, which are enhancing people's experience, lowering the per capita cost of healthcare, enhancing population's health, and enhancing the profession of healthcare providers in there triple aim framework did not recognize the benefaction of employees in the healthcare system. This 2008 model has been extended by Kim et al. (2016) to consider the benefits of nurses, physicians, and other employees in the healthcare system in uncovering satisfaction and joy in their jobs. Other than improving patients' experience, reducing healthcare costs, and clarifying popula- tions' health, the Quadruple objective offers a fourth objective of enhancing the profession of healthcare employees. Applying Evidence-based practices (EBP) in the healthcare system has also led to improved healthcare employees' profession in the healthcare system. Kim et al. (2016) suggest that evidence-based practice

may have an effect on the Quadruple Aim in healthcare, which enhances job satisfaction among healthcare employees and group cohesion. Evidence-based practice is one of the most effective problem-solving approaches in the healthcare system since it combines the best current evidence from the best scientific studies, values, and preferences of clinicians to offer decisions involving patient care. Due to this, the evidence-based practice may not affect the Quadruple Aim since it makes sure that patients receive safe and high-quality healthcare services and the healthcare workers are satisfied with their jobs. Sikka, Morath & Leape (2015) suggest that job satisfaction is fortified through EBP implementation and beliefs. However, other studies suggest that there no crucial correlation between EBP implementation and th h i d tt ti f O j bl i d h hi i th Q d l Ai ' bj ti i th h lth t i h i l

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the cohesion and attractiveness of a group. One major problem experienced when achieving the Quadruple Aim's objectives in the health sector is enhancing popula- tion health while reducing the costs related to healthcare, which needs a high level of effectiveness and efficiency. A productive healthcare workforce brings

about an effective healthcare system. This encouraged the transition of the triple aim and quadruple aim by adding the fourth objective of enhancing the health provider's work-life. This objective, which is also provided by the evidence-based practice, nurses, has greatly supported the positive attitude regarding EBP. Most of them are ready to acquire the required skills and knowledge to adapt to clinical practices. Developing and adapting the evidence-based practice is to enhance the standards of healthcare services that patients get as well as the positive impact it has brought about on the profession of healthcare professionals.

Impact of EBP on factors affecting Quadruple Aim elements

The evidence-based practice involves seven-step problem-solving strategies which can assist the healthcare system in achieving the Quadruple Objective in healthcare through increasing healthcare standards and safety, reducing healthcare cost, and encourage clinicians to be engaged and be more satisfied as they carry out their daily jobs (Anandarajah, Quill & Privitera, 2018). With the current situation, healthcare professionals face high levels of burnout and are dissatisfied with their jobs, but the EBP assists them in meeting the Quadruple Aim. Nurses undergo Evidence-based practice training to acquire the required knowledge components that enable the nurses as well as other healthcare providers to change research findings to clinical practices (Crabtree, Brennan, Davis & Coyle, 2016). With the current situation, EBP is essential for achieving the Quadruple Aim in the healthcare system, and management has to understand that that EBP will directly lead their organization to achieve the quadruple aim, thus improving healthcare quality and safety of the workforce, improve health outcomes, reduce healthcare cost and create job satisfaction for all the employees.

The connection between EBP and Quadruple Aim

The introduction and adoption of evidence-based practice are mostly to enhance the quality of healthcare services that clients receive and provide high-value inpa- tient healthcare in healthcare facilities. Evidence-based practice directly affects the profession of healthcare professionals since to be high quality and safe healthcare services that the employees require to be very productive. The evidence-based practice may not or may assist in achieving the four standards: patient experi-

ence, population health, costs, and profession of healthcare professionals. Patient experience

All measured applied in evidence-based practice allows healthcare providers to change the findings of the research to clinical practice through making use of efficient searching skills of literature and properly to apply the rules that regulate evidence to analyze the results of the research; physicians and nurses can effectively use available scientific knowledge in clinical practice depending on patients requirements. Due to this, the patient is able to experience improved qualities of healthcare services since most current healthcare facilities have started to adopt evidence-based practice to deal with their clinical problems that affect patient care. Population health

The main purpose of evidence-based practice is to make the population have an understanding of their own health determinants, the advantages and complications of some particular treatments, culture, and healthcare practices. The integration of evidence-based practices in different population settings is to make sure that there is an equal distribution of resources to achieve a particular objective (Galiano, Simonetti, Quiroga & Larrain, 2020). Difference populations can be identified de- pending on their requirements as recognized by socioeconomic status, family support, and individual health status, which motivates equity and efficiency during allo- cation as well as the distribution of resources for health promotion. The processes involved in evidence-based practice have been particularly designed to cater to pa- tients' requirements rather than shape healthcare patterns depending on subgroups. Cost

One of the main complications that healthcare facilities face is having a relation to the measure of per capita cost of healthcare as it requires all healthcare expendi- ture to be recorded measurements of actual costs and indexing the cost to the healthcare market. Crabtree, Brennan, Davis & Coyle (2016) suggest that the most usu- al method applied to measure verified costs is ricing and discount, which makes most healthcare facilities challenging to offer safe and quality healthcare services that are at an affordable cost. Due to this, when most healthcare facilities advance to the use of the latest technology to enhance efficiency and have the current treatment methods that are considered by the EBP, the quality of care and the cost will increase. The work-life of healthcare providers

The main features of a conducive healthcare environment should support inter-professional collaboration, which has been evidenced to enhance patient health out- comes and how satisfied healthcare providers are. This also leads to reduced healthcare providers' burnout and turnover rates, which encourages staff productivity. The 3 main features of an environment that encourages staff productivity include actively engaging the employees in shared decision making and the structural and policy. Conclusion

This article has covered how the EBP may affect or not affect the Quadruple Aim, the impact EBP may have on components affecting the Quadruple Aim features, and the relationship in evidence based practice and Quadruple Objective. How the EBP might affect or not affect the Quadruple Aim the EBP enhances healthcare quality, reduces cost, and improves patients' outcomes, making the operation of healthcare providers easy by introducing culture and environment that reduces burnout and creates job satisfaction. The Quadruple Aim has elements such as eliminating healthcare workforce burnout, and this is affected by EBP since it introduces a new cul- ture and workplace environment that reduces workforce burnout and improves job satisfaction. Reference

Anandarajah, A. P., Quill, T. E., & Privitera, M. R. (2018). Adopting the quadruple aim: the University of Rochester Medical Center experience: moving from physi-

cian burnout to physician resilience. The American journal of medicine, 131(8), 979-986. Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving Pa-

tient Care Through Nursing Engagement in Evidence Based Practice. Worldviews on Evidence Based Nursing, 13(2), 172-175. Galiano, A., Simonetti, M., Quiroga, N., & Larrain, A. (2020). Development, implementation, and evaluation of an evidence based practice model in a new hospital in Chile. Journal of Nursing Management, 28(7), 1748-1757. Sikka, R., Morath, J. M., & Leape, L. (2015). The quadruple aim: care, health, cost, and meaning in work. Kim, S.

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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.

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Since EBP is found to encourage health- care providers, thus resulting in better job satisfaction, it can also assist the healthcare system in achieving the Quadruple Aim.

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Because EBP has been found to empow- er clinicians and result in higher levels of job satisfaction, it also can assist health- care systems in achieving the Quadruple Aim

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Kim et al.

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and Kim et al

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A productive healthcare workforce brings about an effective healthcare system.

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A strong foundation of an effective healthcare system is a productive and engaged workforce

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Impact of EBP on factors affecting Quadruple Aim elements

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The impact EBP might have on factors affecting Quadruple Aim elements are analyzed below

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The connection between EBP and Quadruple Aim

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Connection Between EBP and the Quadruple Aim

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patient experience, population health, costs, and profession of healthcare professionals.

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Patient experience Population health Costs Work life of healthcare providers"\"

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The work-life of healthcare providers

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The work-life of healthcare providers

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Adopting the quadruple aim: the Univer- sity of Rochester Medical Center experi- ence: moving from physician burnout to physician resilience.

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Adopting the Quadruple Aim The Univer- sity of Rochester medical center experi- ence moving from physician burnout to physician resilience

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Crabtree, E., Brennan, E., Davis, A., & Coyle, A.

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Crabtree, E., Brennan, E., Davis, A., & Coyle, A

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Improving Patient Care Through Nursing Engagement in Evidence Based Practice. Worldviews on Evidence Based Nursing, 13(2), 172-175.

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Improving patient care through nursing engagement in evidence-based practice Worldviews on Evidence-Based Nursing, 13(2), 172–175

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Sikka, R., Morath, J. M., & Leape, L.

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Sikka, R., Morath, J M., & Leape, L

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The quadruple aim: care, health, cost, and meaning in work.

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The Quadruple Aim Care, health, cost and meaning in work

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C., Stichler, J. F., Ecoff, L., Brown, C.

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C., Stichler, J F., Ecoff, L., Brown, C

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E., Gallo, A. M., & Davidson, J.

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E., Gallo, A M., & Davidson, J

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Predictors of Evidence Based Practice Implementation, Job Satisfaction, and Group Cohesion Among Regional Fellow- ship Program Participants. Worldviews on Evidence Based Nursing, 13(5), 340- 348.

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Predictors of evidence-based practice im- plementation, job satisfaction, and group cohesion among regional fellowship pro- gram participants Worldviews on Evi- dence-Based Nursing, 13(5), 340–348