IHI first articulated the Triple Aim in 2008 as a provocation and ultimate destination for high-performing health systems of the future. This simple, but transformative, framework spread around the world and helped health care organizations of any type and size organize their improvement efforts around the three aims of improved quality of care, improved population health, and lower per-capita costs.

Responding to a crisis of burnout in health care, and mirroring IHI’s own intensifying focus on workforce well-being and joy in work, Drs. Thomas Bodenheimer and Christine Sinsky, in 2014, effectively argued for an expansion of the Triple Aim to a “Quadruple Aim” with an explicit focus on improving the work life of health care providers.

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Then, in 2022, IHI’s President and CEO, Dr. Kedar Mate, along with Drs. Shantanu Nandy and Lisa Cooper (and building on the thinking of Dr. Dipti Itchhaporia) argued for a further expansion — adding an explicit focus on health equity. 

This expanded “Quintuple Aim” is necessary because the Triple Aim is not achievable without attention to health care burnout and inequity. The pursuits of workforce well-being and health equity are fundamental to all other aims.

The Quintuple Aim framework provides health systems, public health organizations, and governments a way to design and assess improvements and solutions according to all five aims. In working to optimize all five, they can redesign care to meet the needs of patients, caregivers, and society as a whole.