The implementation of ACA and the introduction of triple aim are forces that are influencing the healthcare delivery system in the United States (Marshall & Broome, 2017). Management of healthcare costs is one of the goals of the triple aim and can be a reason for managing the competing needs within the organization. Implementing cost containment has been the strategy of most organizations to maintain economic healthcare stability (Jones, Bae, Murry, & Hamilton, 2015). The competing needs of the workforce, resources, and patients may impact the development of policy. Most hospitals are operating under the business model of healthcare which is focusing on providing quality care with the least amount of costs to the organization. The value-based payment (VBP) is an initiative by CMS to incentivize hospitals and providers to invest in strategies that improve the quality of care and patient outcomes (Jones et al., 2015). In the case of adverse events within the hospitals, there will be a penalty and no payments to the hospitals. This penalty would affect the financial operation of the hospitals. This business model type of healthcare requires reductions in either workforce or resources and promotes standardized approaches that often have inflexible policies and regulations (Kelly & Porr, 2018). The result of these policies can frequently provide little room for tailoring and accommodating holistic patient care needs (Kelly & Porr, 2018).

Adoption of new technological innovations such as health IT can be a competing need that can temporarily impact nurse staffing issues. Investing in resources that can improve quality care requires a strategy such as reductions in the workforce to accommodate the adoption of EHR financially. The adoption of EHR, one which promotes meaningful use, can provide financial incentives to the organization (Marshall &  Broome, 2017). Although the adoption of EHR might seem to be a competing need within an organization, the effect of it can boost Medicare reimbursement. The other positive impact of health IT is an improvement in the performance of interdisciplinary communication, a decrease in adverse patient events and improved patient satisfaction (Hessels, Flynn, Cimiotti, Bakken, & Gershon, 2015). Depending on the quality of the technology and the leadership effort, the negative impact can also occur during the implementation process.  Organizational policies need to address the issues related to the implications of the competing needs between the adoption of EHR and the shortage of nurse staffing within an organization. A well designed EHR, one that is supportive of the nursing work environment, will improve patient care and improve staff satisfaction. Policies must promote a strong fundamental quality of care (Hessels et al., 2015), such as adequate staffing and resources to improve quality care and reduce costs. The organizational administration must implement training programs to the staff and professionals in the implementation of EHR to prevent negative impact and to meet the demands of the American Reinvestment and Recovery Act (ARRA) and Affordable Care Act (ACA) (Hessels et al., 2015).  Meeting the provisions of ARRA and the ACA, which establish the VBP program, can enhance the financial capacity of an organization and will likely improve the nurse staffing issues. And as a result, it can achieve the quadruple aim in healthcare.