Notwithstanding important contributions of the Triple Aim, uncristal enthusiasm regarding the implications of the framework may be leading to  inconsistent use, particularly when apploed at the health system level, which goes beyond he original positioning of the framework as a strategic organizing principle to guide improvement initiatives at the organizational or local community level. This article identified uses of the Triple Aim that extended beyond its original intention to focus on uses at the whole health system level, to assess convergence and divergence with the original definition. They also attempted to identify consistencies in the way the Triple Aim was adapted for different contexts and settings.