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Int J Qual Health Care. 2016 Dec 1;28(6):830-837. doi: 10.1093/intqhc/mzw118.

Triple Aim in Canada: developing capacity to lead to better health, care and cost.

Author information

University of Ottawa, Faculty of Health Sciences, 451 Smyth Rd, Ottawa, ON K1H 8M5, Canada.
Canadian Foundation for Healthcare Improvement, 1565 Carling Avenue, Suite 700, Ottawa, ON K1Z 8R1, Canada.
Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.
Department of Medicine, University of Toronto, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.


Quality problem:

Many modern health systems strive for 'Triple Aim' (TA)-better health for populations, improved experience of care for patients and lower costs of the system, but note challenges in implementation. Outcomes of applying TA as a quality improvement framework (QI) have started to be realized with early lessons as to why some systems make progress while others do not.

Initial assessment:

Limited evidence is available as to how organizations create the capacity and infrastructure required to design, implement, evaluate and sustain TA systems.

Choice of solution:

To support embedding TA across Canada, the Canadian Foundation for Healthcare Improvement supported enrolment of nine Canadian teams to participate in the Institute for Healthcare Improvement's TA Improvement Community.


Structured support for TA design, implementation, evaluation and sustainability was addressed in a collaborative programme of webinars and action periods. Teams were coached to undertake and test small-scale improvements before attempting to scale.


A summative evaluation of the Canadian cohort was undertaken to assess site progress in building TA infrastructure across various healthcare settings. The evaluation explored the process of change, experiences and challenges and strategies for continuous QI.

Lessons learned:

Delivering TA requires a sustained and coordinated effort supported by strong leadership and governance, continuous QI, engaged interdisciplinary teams and partnering within and beyond the healthcare sector.


Triple Aim; integrated care; population management; quality improvement

[Indexed for MEDLINE]
Free PMC Article

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