© 2013 Chris Trimble

Presented by:Chris Trimble Adjunct ProfessorDartmouth College

Leading Innovation in Health Care Delivery

© 2015: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged.I receive royalties from sales of the above-pictured book. I have no other conflicts of interest to report.

© 2015 Chris Trimble

© 2015 Chris Trimble

Who invited this guy?

© 2015 Chris Trimble 4

Agenda

• The Cheap and Curative Pill

• Bright and Shiny New Objects

• The Prescription

• The Happiest Physicians

© 2015 Chris Trimble 5

The Cheap and Curative Pill

© 2015 Chris Trimble

Cost

Out

com

esA Cheap and Curative Pill

1940

© 2015 Chris Trimble

Cost

Out

com

esInnovation in Aggregate

1940

© 2015 Chris Trimble

Cost

Out

com

esBiosciences-Driven Innovations

1940

1990

19701960

19802000

1950

2010

© 2015 Chris Trimble

Cost

Out

com

es

1940

1990

19701960

19802000

1950

2010

Biosciences

DrivenInnovation

Cost

Co

nstr

aint

The Cost WallWhat Now?

© 2015 Chris Trimble

Cost

Out

com

es

1940

1990

19701960

19802000

1950

2010

Biosciences

DrivenInnovation

Cost

Co

nstr

aint

A Second Kind of Innovation

Innovation in Health Care

Delivery

© 2015 Chris Trimble 11

Bright and Shiny New Objects

© 2015 Chris Trimble 12

© 2013 Chris Trimble

Innovation is a two-part challenge:

IDEASEXECUTION

© 2013 Chris Trimble

The EXECUTION challenge:UnderestimatedUnderinvested

© 2015 Chris Trimble 15

An Exception to the Rule

IDEAS EXECUTION

BiosciencesDriven

InnovationREALLYHARD HARD

Innovation in Health Care

DeliveryREALLYEASY HARD

© 2015 Chris Trimble 16

Innovation in Health Care DeliveryFour Categories, Four Simple Ideas

1. Standardization

2. Coordination

3. Prevention

4. Improved Medical Decisions

© 2015 Chris Trimble

A Simple Innovation MapWhere is the Opportunity?

LargeSmall

InnovationImprovement

© 2013 Chris Trimble

Physics of Innovation

Rtot = Rops + Rinn

© 2015 Chris Trimble 19

The Critical Resource: TIME

People

Frac

tion

of T

ime

10%

80%

90%

70%

60%

40%

50%

30%

20%

100%

Ongoing Operations

0%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

© 2015 Chris Trimble 20

Part Time Contributions from All

People

Frac

tion

of T

ime

10%

80%

90%

70%

60%

40%

50%

30%

20%

100%

Ongoing Operations

0%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Innovation

© 2013 Chris Trimble

The Fundamental LimitationProject Size

© 2015 Chris Trimble 22

Full Time Contribution from a Few

People

Frac

tion

of T

ime

10%

80%

90%

70%

60%

40%

50%

30%

20%

100%

Ongoing Operations

0%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Inno

vati

on

© 2015 Chris Trimble 23

Innovation with Full Timers

• Bigger Projects

• Resources are More Reliably Available

• Ability to Practice Clean Slate Team Design(Without Breaking Anything)

© 2015 Chris Trimble 24

This Approach Does Not Enable Clean Slate Team Design

People

Frac

tion

of T

ime

10%

80%

90%

70%

60%

40%

50%

30%

20%

100%

Ongoing Operations

0%0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Innovation

© 2015 Chris Trimble

LargeSmallAll,

Part Time

A Few,Full

Time

A Simple Innovation MapWhere is the Opportunity?

© 2013 Chris Trimble

A “Lab” or “Innovation Center”May Not Be the Answer

© 2013 Chris Trimble

Team Redesign …

…lies at the very core of innovation in

health care delivery.

© 2013 Chris Trimble

Team Based Medicine

Step One:Build New Teams

From Scratch

© 2015 Chris Trimble

A Simple Innovation MapWhere is the Opportunity?

Large SmallBright, Shiny,

and New Comfort

Zone

© 2015 Chris Trimble 30

The Prescription

© 2015 Chris Trimble 31

Primary Children’s Hospital (Salt Lake City)

1. The Population

Children with Complex Medical Conditions.

2. The Intervention

Heavyweight Primary Care. More care planning, care coordination, and close contact with families.

3. Results

Outcomes up. Costs down >10%. Patients more satisfied.

© 2015 Chris Trimble 32

The Prescription:

1. Accelerate the transition to value-based payments.

2. Make more bets on full time teams.

© 2013 Chris Trimble

The Happiest Physicians

© 2015 Chris Trimble 34

Physician Innovators

1. Choose a Patient Population

2. Understand the Needs of the Population

3. Design and Build Teams From Scratch

4. Invent Operating Routines From Scratch

5. Measure Costs and Outcomes

© 2013 Chris Trimble

Greater Autonomy

Plus

Greater Accountability

© 2013 Chris Trimble

Questions

© 2015 Chris Trimble 37

Team DesignInnovation in Established Organizations

PARTNER-SHIP

DedicatedTeam

SharedStaff

© 2013 Chris Trimble

© 2013 Chris Trimble

www.physicianinnovators.net

© 2015 Chris Trimble

© 2013 Chris Trimble

Presented by:Chris Trimble Adjunct ProfessorDartmouth College

Leading Innovation in Health Care Delivery

© 2015: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged.I receive royalties from sales of the above-pictured book. I have no other conflicts of interest to report.