NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

ORDER NOW FOR AN ORIGINAL PAPER!!! NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

With increasing healthcare demand, the healthcare system has been advancing drastically over the years, with the introduction of  Evidence-based Practice (EBP) for the provision of safe and quality care. Several models such as the triple aim which has evolved to quadruple aim have also been established to promote population health with enhanced patients experience at a reduced cost (Bowles et al., 2018). Healthcare experts believe that the incorporation of EBP into current clinical practice will help reach the Quadruple Aim. As such, the purpose of the present paper is to discuss the quadruple aim and its role in evidence-based practice.

EBP and the Quadruple Aim on Patient Experience

The quadruple aim is focused on the creation of better care output among patients, at a reduced cost, with an improved experience for both the patient and the healthcare provider. With EBP, all the four measures of the quadruple aim can be achieved. For instance, utilization of EBP in the delivery of care and decision-making process on the most appropriate intervention promotes the experience of the patient, with improved care outcome (Haverfield et al., 2020). Patients tend to feel safe when clinicians utilize evidence-based treatment approaches when taking care of them.

EBP and the Quadruple Aim on Population Health

Concerning population health, EBP promotes the utilization of research in better understanding the characteristics, values, needs, and preferences of a certain population, which are key elements in care delivery. For instance, common chronic illnesses such as diabetes and cardiovascular conditions have posed great challenges over the years, with increasing morbidity and mortality rates (Wagner et al., 2018). However, EBP, through research has led to the introduction of novel approaches which are time efficient and easily accessible helping populations with the highest prevalence of these comorbidities hence promoting the achievement of the quadruple aim.

EBP and the Quadruple Aim on Healthcare Cost

Additionally, with the introduction of EBP, clinicians have reported improved prognosis of several health complications with has reduced hospitalization rate hence reduced healthcare costs. Consequently, the use of proven diagnostic tools and treatment approaches has led to a reduced treatment period, hence reducing the costs associated with diagnostic tests and medication (Haverfield et al., 2020). Clinicians have also been trained to utilize cost-effective care approaches and avoid unnecessary procedures to help reach the quadruple aim.

EBP and the Quadruple Aim on Work-Life of Healthcare Providers

Lastly, despite EBP promoting patient-centered care, the experience of the healthcare workforce has also been considered for optimal care benefits. As the fourth element of the quadruple aim, EBP has ensured that clinicians are adequately trained to utilize time-saving and effective medical tools, to improve the efficiency of the care process (Haverfield et al., 2020). The current healthcare system has introduced several interventions through EBP to decrease provider burnouts, stress, and depression which would otherwise lead to poor health outcomes and decreased patient satisfaction.


            The healthcare system has evolved over the years towards the provision of safe and quality services. Currently, clinicians are encouraged to utilize EBP in care provision to improve the quality and efficiency of care provided at a reduced cost (Wagner et al., 2018). In the same line, the quadruple aim which evolved recently from the triple aim focuses on four main elements which can be achieved with the incorporation of EBP into current clinical practice.

The primary goal of the quadruple aim is to promote and improve higher-quality patient care experiences (Sikka, Morath, & Leape, 2015). EBP strategies can be used by clinicians and medical professionals to conduct research and then translate the findings into useful clinical roles. While evaluating study findings, use knowledge, methods for locating relevant content, and EBP concepts. As clinical nurses, we are always using the most up-to-date scientific information to provide care to our patients (Melnyk, 2018). This enables us to address the unique needs and challenges that each patient brings to treatment. EBP eventually allows nurses to provide better patient care in a variety of settings (Crabtree, Brennan, Davis, & Coyle, 2016). More importantly, EBP considers the patient’s preferences and values, allowing for the most successful patient care (Melnyk & Fineout-Overholt, 2018).

the health of the population

The Centers for Disease Control (CDC) and other major government agencies require EBP-tested solutions, particularly during the funding phase of population-based chronic disease prevention and control (Allen et al., 2018). This can lower illness load on populations while improving overall population health (Allen et al., 2018). Furthermore, the Quadruple Aim advocates for better patient outcomes and the promotion of higher-quality healthcare (Melnyk & Fineout-Overholt, 2018).


As a result of the use of evidence-based nurse retention methods, nursing leaders have been able to create policies and plans that will promote greater job satisfaction and, over time, boost the retention of newly hired nurses (Tang & Hudson, 2019). High nursing staff turnover can be expensive and has a detrimental influence on patient care’s safety and standard of care (Tang & Hudson, 2019). The quadruple aim can be achieved by using EBP to enhance clinician work satisfaction, cut needless spending, and improve patient care and results (Tang & Hudson, 2019).

NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

hours of operation for healthcare professionals

Numerous studies have shown that nurses with EBP knowledge and training have more effective educational backgrounds and attitudes (Kim et al., 2016). A well-designed healthcare system is built on a quadruple goal, which is the cornerstone and beating heart of clinicals who are assured and empowered in their professions (Kim et al., 2016).

In conclusion, the quadruple goal is affected by the use of EBP in patient care, total population health and well-being, expenses, and clinical practices of a medical professional. The EBP principle promotes quality patient outcomes, gives clinicians and medical professionals more control, and helps build and create optimal patient care.

In this week’s assignment I will briefly describe and analyze the similarities and connection between Evidence-based practice (EBP) and the Quadruple Aim (QA). This paper is primarily focused on how EBP might (or might not) help reach the Quadruple Aim. It will each of the four measures of patient experience, population health, costs, and work-life of healthcare providers. Finally, the impact that EBP may have on factors affecting these quadruple aim elements, such as preventable errors in a clinical setting or nursing practice will also be considered.

Evidence-based practice is a method that assists clinical practitioners in determining the best course of action based on the values of their patients, relevant external research, and the clinician’s own experience. When it comes to the best principle that facilitates the patient’s experience with the capability of the clinician’s experience, and up-to-date knowledge, EBP is a good choice (Petra Dannapfel, 2015). It is implementing a problem-solving strategy in healthcare delivery that includes the most appropriate conclusions based on research that has been tested clinician expertise, medical practitioners, and patient preferences and outcomes (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010).

The Quadruple aim combines the clinician’s experience, the patient’s experience, optimal outcomes, and the costs of the whole practice involved altogether. The quadruple aim focuses not only on the patients, health practitioners but also on the cost of the method. It enhances healthcare quality and patient outcomes, eliminates unnecessary costs, reduced costs, and empowered clinicians by the utilization of EBP (Melnyk & Fineout-Overholt, 2018).

Patient experience


Allen, P., Jacob, R., Lakshman, M., Best, L. A., Bass, K., & Brownson, R. C. (2018, Oct). Lessons learned in promoting evidence-based public health: Perspectives from managers in state public health departments. Journal of Community Health, 43(5), 856-863.

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172-175.

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A., & Davidson, J. E. (2016, Oct). 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.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry. In B. M. Melnyk, Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed. (pp. 7-32). Philadelphia, PA: Wolters Kluwer.

Pannunzio, Valeria, Kleinsmann, Maaike. (2019). Design research, eHealth, and the convergence revolution. Retrieved from

Petra Dannapfel. (2015). Evidence-Based Practice in Practice: Exploring Conditions forUsing Research in Physiotherapy. Retrieved from

  1. Mauricio Barría P. (2014). Implementing Evidence-Based Practice: A challenge for the nursing practice. Retrieved from

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24(10), 608-610.

Tang, J. H., & Hudson, P. (2019, Nov). Evidence-based practice guideline: Nurse retention for nurse managers. Journal of Gerontological Nursing, 45(11), 11-19.

NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

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Read Also: NURS 6052 Assignment: Evidence-based Project Walden

Evidence-Based Practice and Quadruple Aim

The performance of healthcare organization is often measured based on metrics such as costs of operation, quality of care, and improved patient experiences. The implication is that healthcare organizations are striving to ensure that these outcomes are met. They are in constant search of leadership as well as management models that will provide them with the competitive edge they desire in their markets. They also consider the use of quality improvement models as well as theories that would increase their productivity and performance. Over time, the increased focus on performance, productivity, safety, and efficiency have led to the rise of two models of healthcare practice that include evidence-based practice and the Quadruple Aim. Quadruple Aim and evidence-based practice focuses on improving healthcare outcomes by focusing on aspects that include patient experience, population health, costs, and work life of the healthcare providers. While these models of care promise to improve health outcomes, their role in underpinning each other’s success has not been explored. Therefore, this essay examines the manner in which evidence-based practice help reach Quadruple Aim.

Dang et al., (218) define evidence-based practice as the provision of healthcare based on the best available clinical evidence on the efficacy of the interventions used. It also entails taking into account the patients’ preferences and values, as well as the expertise of the healthcare providers, when determining the patients’ care needs. Increased use of evidence-based practice has been shown in studies to result in patient and provider satisfaction, improved quality and safety of care, and cost savings in healthcare. The Quadruple Aim is a model of care introduced by the Institute for Health Improvement to improve patient experiences, population health, healthcare costs, and healthcare providers’ work lives.

In many ways, evidence-based practice aids in the achievement of the Quadruple Aim. The practice focuses on providing care using the best available clinical evidence. Healthcare providers must conduct a critical review of the available evidence on meeting the health needs of diverse populations. The evaluation enables them to identify the best care approaches in terms of efficiency, quality, and safety (Yoder-Wise, 2019). It achieves patient outcomes such as access to safe, quality, and efficient care, thereby realizing the Quadruple Aim. Evidence-based practice is also concerned with lowering healthcare costs. Its application saves money in a variety of ways. First and foremost, healthcare providers prioritize patient safety and optimal recovery. Reduced hospital readmissions, unnecessary costs incurred due to adverse events, and shorter hospital stays all contribute to lower healthcare costs. Furthermore, EBP integrates healthcare providers’ experience, research, and patients’ values and preferences to drive optimum outcomes and best care in clinical settings (Garrett, 2018). Such outcomes include improved patient experiences, population health, care outcomes, and lower healthcare costs, resulting in the indirect realization of the Quadruple Aim.

There is also a correlation between the utilization of evidence-based practice with staff satisfaction. Evidence-based practice updates nursing practice, informs the use of efficient interventions in healthcare, and utilizes research to evaluate the work environment. Evidence-based practice encourages the use of modern methods of providing healthcare. The methods focus on the efficient use of the available resources. They also encourage the need for continuous development of the staffs, as a way of improving the care offered to those in need. There is also the evidence that it encourages staffs to engage in activities that promote the creation of safe working environment (Kang, 2016). Consequently, the wellbeing of the healthcare providers is enhanced due to safe working conditions, hence, the indirect realization of the Quadruple Aim.

In summary, evidence-based practice, helps improve the Quadruple Aim. It underpins the initiatives that should be adopted for the realization of the objectives of Quadruple Aim. Evidence-based practice focuses on improving healthcare metrics such as safety, quality, patient experiences, staff outcomes, and healthcare costs. These outcomes are also evident in Quadruple Aim. Therefore, as healthcare organizations focus on adopting evidence-based practice, the outcomes of Quadruple Aim will be met indirectly.


Dang, D., Dearholt, S., Sigma Theta Tau International., & Johns Hopkins University. (2018). Johns Hopkins nursing evidence-based practice: Model and guidelines. Indianapolis, IN : Sigma Theta Tau International.

Garrett, B. (2018). Empirical nursing: The art of evidence-based care. Bingley, UK: Emerald Publishing Limited.

Kang, H. (2016). Evidence-Based Practice and Job Satisfaction of Nurses in Long-Term Care. Open Journal of Nursing6(12), 977.

Yoder-Wise, P. S. (2019). Leading and Managing in Nursing. New York: Mosby.

NRSE 6052 Week 1 Assignment EBP and the Quadruple Aim
NRSE 6052 Week 1 Assignment EBP and the Quadruple Aim

NURS 6052/NURS5052/NRSE6052 Essent of Evidence

Week 2 Quiz

Question 1 What type of study is described in the following excerpt?

An interprofessional team wants to test a new intervention to see whether it will improve central-line associated bloodstream infection (CLABSI) rates. Subjects were randomized into either the intervention or the control group by pulling a slip of paper with either a one or a two written on it from a manila envelope (those pulling ones were randomized to the intervention group; those pulling twos were randomized to the control group). When the study began, the intervention group received the intervention and the control group received equal attention. Data was collected and analyzed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics were used to report the data. NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

Surveys to evaluate nurse satisfaction, medical errors, depression and anxiety, and demographics were given to 5,432 nurses from hospitals of various sizes and geographic locations; some had nurses working 8-hour shifts and 12-hour shifts. Nurses were asked to complete the survey. Upon completion of the survey, nurses were invited to participate in video conference focus groups and one-on-one interviews with a research assistant by video conferencing. Survey results were reported using descriptive statistics, and themes were identified and reported from the data collected in the focus groups and one-on-one interviews.

Question 9Which of the following statements is true of narrative reviews? (Select all that apply.)

Question 10In a systematic review with a meta-analysis, researchers combine the results of each of the individual studies to create a larger sample size (and therefore greater power), then re-run the statistics to capture the true magnitude of the effect. The single-effect measure calculated and reported when the results from all the studies are combined is called what?

Question 11In quantitative studies, results are reported using words or themes.

Question 12What types of information would help you identify a research study as quantitative? (Select all that apply.)

Question 13What kind of study is described in the following excerpt?

Question 14What type of literature may a systematic review include to be considered Level 1 evidence on the Melnyk & Fineout-Overholt levels of evidence hierarchy?

Question 15Randomized controlled trials are which type of research?

Question 16Order the following types of research evidence reviews in order of rigor from most rigorous to least rigorous:

Question 17When trying to determine what type of research study is described in an article, which two sections of the article will give you the best information to make that determination?

Question 18Both literature reviews and systematic reviews are types of research evidence reviews.

Question 19A key characteristic of a systematic review is that it contains a meta-analysis.

Question 20Which of the following types of research can be categorized as primary research? Select all that apply. NRSE 6052 Week 1 Assignment: EBP and the Quadruple Aim

RE: Discussion – Week 1

One of the best-known and most-referenced professional nursing organizations is the American Nurses’ Association. I’m most familiar with their political activism and the various perks for nurse members. I went back to their website and navigated to their position statements page using my evidence-based practice lens. Their official policy statements cover a wide range of topics, such as “patient safety” and “electronic health records,” as well as topics like “workplace advocacy.” Using evidence-based practice, Crabtree et al say that nurses have a vital role to play in improving patient outcomes. “The staff nurse is a vital link in implementing evidence-based improvements into clinical practice” (Crabtree et al, 2016). (Crabtree et al, 2016). The ANA leverages evidence-based practice to influence its official position statements, and then enables nurses through membership to integrate that knowledge into their clinical surroundings. One of the ANA’s position statements promotes safe delivery of medication in older individuals. Considering that in older patients, medication errors have been connected to both harm and death, evidence-based practice clearly supports this claim.

ANA Position Statement – Promoting Safe Medication Use in the Older Adult. (2021). ANA.

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving Patient Care Through Nursing Engagement in Evidence-Based Practice. Worldviews on Evidence-Based Nursing13(2), 172–175.

Relationship between evidence-based practice and the quadruple aim

Evidence-based practice heavily depends on the utilization of available scientific evidence for clinical decision making. Evidence-based practices have continued to gain ground in management, the formation of public policies, education, and nursing practice since their formal introduction in the 1990s. As one of the most effective approaches to problem-solving in clinical settings, evidence-based practice integrates the best available evidence from well-designed scientific studies, the preferences and values of patients, and the clinical expertise to make decisions regarding patient care (Crabtree et al., 2016). Assignment: Sample essay on Evidence-Based Practice and the Quadruple Aim Therefore, the primary objective of evidence-based providers is to provide patients with high-quality and safe healthcare. EBP embraces an interprofessional model that places a significant emphasis on shared decision making in order to maximize the probability of success. Similarly, state, federal, and local actors are necessary for the adoption and implementation of evidence-based practice. According to Crabtree et al. (2016), the majority of nurses are prepared to acquire the necessary skills and knowledge for the implementation of evidence-based practice in clinical settings.

The quadruple aim has four primary objectives: improving patient experience, population health, the work-life of healthcare providers, and lowering healthcare-related costs (Sakallaris et al., 2016). Through the redesign of healthcare facilities, the quadruple aim intends to achieve the aforementioned goals. Improving population health while simultaneously containing/reduc[ing] healthcare-related costs, which necessitates a high level of efficiency and effectiveness, is a significant barrier to achieving these objectives in the broader health sector (Bodenheimer & Sinsky, 2014). A highly effective healthcare system requires a highly productive health workforce. This is what prompted the expansion of the triple aim to the quadruple aim by adding the fourth goal of enhancing the work-life of healthcare providers. Sample essay on Evidence-Based Practice and the Quadruple Aim

The Potential Impact of EBP on Factors Influencing These Quadruple Aim Components.

The development and implementation of evidence-based practice is primarily intended to improve the quality of healthcare services provided to patients, with a particular emphasis on inpatient care in clinical settings. Similarly, evidence-based practice has a direct effect on the work lives of healthcare providers, since staff must be highly productive in order for patients to receive high-quality and safe healthcare services. The purpose of every healthcare institution is to improve the lives of both patients and the healthcare professionals who provide services.

Patient experience

All evidence-based practice strategies permit healthcare providers to implement the research findings in clinical practice. By utilizing effective literature search skills and formally applying the rules that guide evidence evaluation, nurses and other healthcare providers can efficiently apply existing scientific knowledge to clinical practice based on the specific needs of individual patients (Jacobs et al., 2018). As a result, the quality of healthcare services provided to patients is enhanced. In recent years, the majority of healthcare institutions have adopted evidence-based practice to address clinical issues that directly impact patient care; this has resulted in enhanced patient experiences. Sample essay on evidence-based practice and the quadruple aim

Population wellness

The purpose of evidence-based practices is to educate populations on the determinants of health, the benefits and limitations of particular treatments, cultural and healthcare practices. Those who integrate evidence-based practices in diverse population settings also aim to ensure the equitable distribution of resources to attain particular objectives (Sakallaris et al., 2016). The classification of populations according to their needs, as determined by socioeconomic status, family support, and individual health status, promotes equity and efficiency in the allocation and distribution of resources for health promotion. As opposed to shaping healthcare patterns based on subgroups, all evidence-based care processes have been designed specifically to meet the needs of each individual patient.


A significant obstacle for the majority of healthcare facilities is the measurement of per capita healthcare costs, which requires the capture of all healthcare expenditures, measurement of actual costs, and indexing of costs to the healthcare market. According to Sakallaris et al. (2016), discounts and pricing are the most common method for measuring actual costs. Therefore, it is an enormous challenge for the majority of healthcare institutions to provide safe and high-quality care at lower costs. When an institution adopts the latest technology to improve efficiency and the most recent treatment methods as revealed by evidence-based practice, both the quality and cost of care increase automatically.

The daily lives of healthcare professionals

The essential elements of a favorable healthcare environment should facilitate interprofessional collaboration. There is evidence that interprofessional collaboration improves patient health outcomes and the satisfaction of healthcare providers. Additionally, it decreases provider burnout and turnover rates, thereby boosting staff productivity (William et al., 2016). The three major components of such a setting are the structural and policy elements, as well as the active participation of the workforce in shared decision making. Sample essay on evidence-based practice and the quadruple aim


Evidence Based Practice Affecting Patient Experience

Nursing has a long and valued history of using research to impact practice, beginning with the earliest pioneer, Florence Nightingale (Nightingale, 1859). Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical nursing knowledge and patient values to guide healthcare decisions (Jennings & Loan, 2001).

Evidence-based practice holds great promise for moving care to a high level of likelihood for producing the intended health outcome. The definition of healthcare quality is foundational to evidence-based practice.

Leaders in the field have defined EBP as “Integration of best research evidence with clinical expertise and patient values” (Sackett et al, 2000, p. ii). Therefore, EBP unifies research evidence with clinical expertise and encourages individualization of care through inclusion of patient preferences. While this early definition of EBP has been paraphrased and sometimes distorted, the original version remains most useful and is easily applied in nursing, successfully aligning nursing with the broader field of EBP. The elements in the definition emphasize knowledge produced through rigorous and systematic inquiry; the experience of the clinician; and the values of the patient, providing an enduring and encompassing definition of EBP.

Population Health

Nursing research has been impacted by recent far-reaching changes in the healthcare research enterprise. Never in healthcare history has the focus and formalization of moving evidence-into-practice been as sharp as is seen in today’s research on healthcare transformation efforts. Nascent fields are emerging to understand how to increase effectiveness, efficiency, safety, and timeliness of healthcare; how to improve health service delivery systems; and how to spur performance improvement. These emerging fields include translational and improvement science, implementation research, and health delivery systems science.


Investigation into uptake of evidence-based practice is one of the fields that has deeply affected the paradigm shift and is woven into each of the other fields. Investigation into EBP uptake is equivalent to investigating Star Point 4 (integration of EBP into practice). Several notable federal grant programs have evolved to foster research that produces the evidential foundation for effective strategies in employing EBP. Among the new research initiatives are the Clinical Translational Science Awards and the Patient-Centered Outcomes grants.


The leadership and governance of our healthcare systems currently have strong economic and outcome motivations to focus on the Triple Aim. They also need to feel a parallel moral obligation to the workforce to create an environment that ensures joy and meaning in work. For this reason, we recommend adding a fourth essential aim: improving the experience of providing care. The notion of changing the objective to the Quadruple Aim recognizes this focus within the context of the broader transformation required in our healthcare system towards high value care. While the first three aims provide a rationale for the existence of a health system, the fourth aim becomes a foundational element for the other goals to be realized.

Work Life of Healthcare Providers

Progress on this fourth goal in the Quadruple Aim can be measured through metrics focusing on two broad areas: workforce engagement and workforce safety. Workforce engagement can be assessed through annual surveys using established frameworks that allow for benchmarking within industry and with non-healthcare industries. 9 Measures should also be extended to quantify the opposite of engagement, workforce burn-out. This could include select questions from the Maslach Burnout Inventory, the gold standard for measuring employee burn-out. 10 In the realm of workforce safety, metrics should include quantifying work-related deaths or disability, lost time injuries, government mandated reported injuries and all injuries. Although these measures do not completely quantify the experience of providing care, they provide a practical start that is familiar and allow for an initial baseline assessment and monitoring for improvement.


The rewards of the Quadruple Aim, achieved within an inspirational workplace could be immense. No other industry has more potential to free up resources from non-value added and inefficient production practices than healthcare; no other industry has more potential to use its resources to save lives and reduce human suffering; no other industry has the potential to deliver the value envisioned by The Triple Aim on such an audacious scale. The key is the fourth aim: creating the conditions for the healthcare workforce to find joy and meaning in their work and in doing so, improving the experience of providing care.


  1. Nightingale, F. (1859). Notes on nursing. London: Harrison & Sons.
  2. Jennings, B. & Loan, L. (2011). Misconceptions among nurses about evidence-based practice. Journal of Nursing Scholarship, 33(2), 121-127.
  3. Institute of Medicine. (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.
  4. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Committee on Quality of Health Care in America, Institute of Medicine. Washington DC: National Academies Press.
  5. Agency for Healthcare Research and Quality (AHRQ). (2013). Funding and grants. Retrieved from:
  6. Sikka, R., Morath, J.M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24, 608-610. Doi:10.1136/bmjqs-2015-004160