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November-December 2018 - Volume 63 - Issue 6

  • Eric Ford, PhD, MPH
  • 1096-9012
  • 1944-7396
  • 6 issues per year
  • 1.102

From the November/December Issue...

In politics, the “iron triangle” denotes the closed, mutually beneficial relationship among three policymaking entities that ultimately benefits the select few rather than the majority. Healthcare’s iron triangle is the Triple Aim to improve healthcare system performance—essentially cost, quality, and access. In practice, an improvement to any one side of the triangle invariably causes one of the other two sides to suffer. If we reduce costs, quality declines or the ability to see more patients is compromised. If we increase access, costs begin to rise or quality deteriorates. In the worst case, managers systematically restrict access or cherry-pick healthier patients with better insurance to reach organizational targets.

Some of the research in this issue of the Journal of Healthcare Management explores the trade-offs in breaking the iron triangle; typically, the studies address two sides at a time. At the end of this editorial, I explain why researchers should address all three sides in a more holistic fashion. Moving beyond the research domain, I explain why leaders should stop trying to address all three simultaneously and suggest the one they should focus on now.

First, this issue presents an interview with Thomas A. LaVeist, PhD, dean of the Tulane University School of Public Health and Tropical Medicine. Dr. LaVeist is one of the world’s leading authorities on health disparities and shares insights on how they can be addressed. You also can listen to our interview as the second installment in our new podcast, “A Leader Who Cares,” available on the JHM website (via and iTunes.

Next, we conclude our yearlong series of columns on caring for the caregivers with seven things board members should know about burnout, advocated by Tait Shanafelt, MD, Stephen J. Swensen, MD, Jim Woody, MD, PhD, John Levin, JD, and John Lillie. And our yearlong column series on sustaining relevance ends with thoughts on the importance of disruption shared by Ascension President and CEO Anthony R. Tersigni, FACHE.

Continue reading this Issue's Editorial here...

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