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Dr. Kruse & Triple Aim+1

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SIU Medicine and its programs hit the marks

Written by Karen Carlson | Photographed by Jason Johnson

Dean and Provost Jerry Kruse, MD, MSPH, closes nearly every presentation with a particular slide: The Triple Aim + 1. The Triple Aim is a nationally known health care philosophy that has been steadily woven into the fabric of SIU Medicine for years. The Institute for Healthcare Improvement (IHI) published the Triple Aim in 2007. Great minds think alike: the SIU School of Medicine Department of Family & Community Medicine (FCM) had been promoting similar principles for nearly a decade and extending them even further.

FCM first began thinking of a new philosophy of patient care when Dr. Kruse became chair of the Department in 1998. With several faculty members having formal training in public health, Dr. Kruse and the FCM team began focusing on population-based statistics as part of the vision for the department. 

“We began to understand the reasons that health care spending was highest in the world while population-based outcomes in the US paled in comparison to those of other wealthy, industrialized nations, and we thought that we could be a part of the solution,” Dr. Kruse says. 

In 2004 and 2005,  landmark studies that defined effective systems of health care were published. Two were written by Dr. Barbara Starfield of Johns Hopkins Bloomberg School of Public Health. Other researchers validated Starfield’s research, and FCM began with new rigor implementing effective systems of care and studying what family physicians, as usual sources of comprehensive longitudinal care, could do to advance care that improved outcomes, lowered cost and improved access. “It became our focus to build the system across the department,” Dr. Kruse says. As FCM was building that system of certified Patient-Centered Medical Homes, IHI published the Triple Aim 2007.

The Triple Aim, Dr. Kruse notes, simplified the concepts that FCM had studied. “IHI recommended that health systems and medical education systems focus on improving population-based health care options, lowering per capita cost of care and improving patient experience.” At SIU, the FCM team saw potential to expand the three simplified principles. “Improving patient experience doesn’t exactly communicate the essential concept of access for all, and it didn’t communicate the importance of experience for those who provide care and education; we thought that was important too,” Dr. Kruse says. He added the concept of “equity” — justness and fairness for all — and “enjoyable” to the Triple Aim, coining the term “The Triple Aim + 1.” As it turns out, SIU wasn’t the only one with ideas of expanding the Triple Aim. In 2014, Drs. Thomas Bodenheimer and Christine Sinsky published the “Quadruple Aim,” which added one of the same concepts that FCM had been touting – improving the experience for those who provide health care.   

In 2013, Dr. Kruse was named Executive Associate Dean and CEO of SIU HealthCare, and he gave the Triple Aim + 1 institutional standing at SIU Medicine. “We established it as something we aspire to as an organization.” 

SIU Medicine has a robust network of programs today that reflect Dr. Kruse’s vision of the Triple Aim + 1 as the vision of the institution. “Our strategic initiatives, mission and vision all funnel through the 4 E’s of the Triple Aim + 1. We intend that effectiveness, efficiency, equity and enjoyment are characteristics of our goals and strategic initiatives. And these four E’s apply not only to outcomes for our patients but also to the relationships we have with our learners and with each other.”

The development of a school-wide program for population science and health, which includes the Office of Population Science and Policy, led by Dr. Sameer Vohra, the SIU Medicine Office of Population Health, led by Dr. Harald Lausen, and the Office of Clinical and External Affiliations, led by Lori Williams, are  examples of the intentional, strategic effort to use the Triple Aim + 1. These offices are building relationships and creating new models of care delivery that enhance the care experience for patient and provider and improve outcomes for the people and communities to whom SIU Medicine is accountable.  

Specific programs for broad-based inclusion, women in medicine, global health, national leadership, signature conferences, student groups and workshops on dismantling systemic racism are only a few of the initiatives that bring the principle of equity to the forefront. In 2016, the Office of Diversity and Inclusion was established. As new Associate Dean Wendi Wills El-Amin, MD, was hired, “Equity” was added to the name of the office. This addition signaled an intent to establish more programs to promote the justice and fairness across the organization 

SIU Medicine is also a partner in the Midwest Healthcare Quality Alliance (MHQA) – a partnership among SIU Medicine, Memorial Health System and Springfield Clinic, which Dr. Kruse says, is a big step toward fulfilling the Triple Aim+1. The MHQA aims to improve quality, safety, efficiency and outcomes through research, training and new methods of analysis. For example, the MHQA has promoted training in Lean Six Sigma techniques for health care professionals and provides physicians a vehicle to submit quality improvement projects for maintenance of certification requirements.

Dr. Kruse is pleased with the progress of the Triple Aim+1 at SIU, and envisions an even greater role for this concept.  He sees the potential of large databases, big data, and registries to further develop population-based programs for the high-risk, vulnerable populations. “There are a lot of people at SIU now who think in this way. Their efforts have been roundly accepted by everyone. I’m very happy with that. We as an organization strive to be more effective, efficient, equitable and enjoyable.” 

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