This site uses cookies.

Understanding GPs: The Triple Aim as a Management Tool - Dr Mark Burgin

22/01/20. Dr. Mark Burgin BM BCh (oxon) MRCGP explains in the second of series of articles how a management framework from the Institute for Healthcare Improvement is destroying primary care.

The Triple Aim was designed to achieve the impossible, to save money, improve experience of care and the transition to population health.

It has long been recognised that optimising for one or even two dimensions is possible but optimising on three dimensions is mathematically impossible.

Project management describes this as the Iron Triangle but it is more popularly known as Good, Fast, Cheap: You Can Only Pick Two!

Damage to Medical Care

The Triple Aim causes damage to all medical care organisations because it causes distortion of priorities away from patients towards systems.

Doctors determine priorities on clinical need which cannot easily be measured and managers prefer easy to measure issues such as bed occupancy.

In a recent case (Bawa-Garba) the doctor appeared to be more interested in addressing management issues than caring properly for a sick child.

General Practice is more vulnerable

General practice is uniquely vulnerable to damage from the Triple Aim as any distraction in a short consultation means lost effectiveness.

The metrics used to measure performance are taken from secondary care rather based upon the concept of psychosocial progress which I have discussed previously.

In an area of medicine that looks for social and psychological progress over many years a focus on short term targets is peculiarly toxic.

Adjustments to the Triple Aim

There have been attempts to create a fourth aim (Quadruple Aim) to give staff meaning without understanding that clinical need is a key motivation.

Biopsychosocial progress is a better measure of the effectiveness of Primary care as it better reflects what motivates GPs and how it works.

The Triple Aim should be collecting local patient health data so that managers can direct resources so that practices can help their local population.


Managers may dislike treatment based upon clinical need but it is the keystone at the heart of all healthcare and staff motivation.

General practice is holistic and covers social, psychological as well as biological risk factors for disease so is the least understood by managers.

Changing the Triple Aim so that it prioritises those aspects that patients and GPs consider important would take pressure off the GPs struggling to cope.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website › Engage › Initiatives › TripleAim - The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);

  • Improving the health of populations; and

  • Reducing the per capita cost of health care.

Burgin 2020 Understanding GPs: Biopsychosocial Progress.

Sikka 2015 The Quadruple Aim: care, health, cost and meaning in work BMJ Quality and Safety Vol24 Issue 10

Image ©

All information on this site was believed to be correct by the relevant authors at the time of writing. All content is for information purposes only and is not intended as legal advice. No liability is accepted by either the publisher or the author(s) for any errors or omissions (whether negligent or not) that it may contain. 

The opinions expressed in the articles are the authors' own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand. 

Professional advice should always be obtained before applying any information to particular circumstances.

Excerpts from judgments and statutes are Crown copyright. Any Crown Copyright material is reproduced with the permission of the Controller of OPSI and the Queen’s Printer for Scotland under the Open Government Licence.