© 2013 Chris Trimble

Presented by:– Chris Trimble – Professor, Tuck School of

Business at Dartmouth

Leading Innovation in Health CareDelivery

© 2013: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged.I have no conflicts of interest to report.

© 2013 Chris Trimble

Per-Capita Health Expenditure

Len

gth

& Q

uality

of

Lif

e

Role of Innovation in the BiosciencesEXTEND THE CURVE

© 2013 Chris Trimble

Per-Capita Health Expenditure

Len

gth

& Q

uality

of

Lif

e

Role of Innovation in the BiosciencesEXTEND THE CURVE

Innovation in the biosciences

© 2013 Chris Trimble

Per-Capita Health Expenditure

Len

gth

& Q

uality

of

Lif

eWe need a new type of innovation.

Innovation in the biosciences

Innovation in health care

delivery

© 2013 Chris Trimble 5

© 2013 Chris Trimble

Innovation is a two-part challenge:

IDEAS

EXECUTION

© 2013 Chris Trimble

These two parts of the challenge …

… have almost nothing to do with each other

© 2013 Chris Trimble

IDEAS:

invention, creativity, brainstorming, serendipity,

out-of-the-box-thinking,science, technology, strategy, disrupting your competition

© 2013 Chris Trimble

EXECUTION:

the blood, sweat, and tearsof getting the work done.

© 2013 Chris Trimble

Oh, by the way …

…you must succeed at both to win.

© 2013 Chris Trimble

The EXECUTION challenge is a lot harder than (most)

people imagine.

© 2013 Chris Trimble 12

Innovation in Health Care Delivery:

The Ideas are Simple;The Implementation is Hard

© 2013 Chris Trimble 13

Innovation in Health Care Delivery:Four Common Team Charters

1. Standardize, delegate, maximize efficiency(Think: Henry Ford)

2. Coordinate care across the full cycle of care for a medical condition.

3. Prevention: “Hot Spotting”

4. Improved Medical Decisions

© 2013 Chris Trimble

The EXECUTION challenge:

Tackle two tasks at once –

1) Sustain what exists 2) Build something new

© 2013 Chris Trimble

These two tasks are:

very distinct,

and inevitably in conflict.

© 2013 Chris Trimble 16

Business Organizations Are Designed to be Performance Engines

PerformanceEngine

Ongoing Operations• Today’s Customers• Today’s Competitors• Efficiency• Accountability• On-Spec• On-Budget• On-Time• Profitable

© 2013 Chris Trimble 17

Fundamental Incompatibilities

PredictabilityRepeatabilityMethod ofthe PerformanceEngine

UncertainNon-RoutineRealities of Innovation

© 2013 Chris Trimble

Resources for Innovation are Scarce!

PerformanceEngine

Innovation

18

© 2013 Chris Trimble 19

Health Care is Different

AmericanHealth Care

Engine

Ongoing Operations

• Cutting Edge Science• Cutting Edge Technology• Advanced Diagnostics• Advanced Therapies• Every Patient Deserves Best• Get Payers to Pay• No Margin, No Mission

© 2013 Chris Trimble 20

The system we have has been…

… perfectly aligned for innovation in the biosciences …

… and perfectly misaligned for innovation in health care delivery

(though that is changing)

© 2013 Chris Trimble 21

Fundamental Incompatibilities:“Two Canoes”

ValueVolume vs.

Low TechHigh Tech vs.

PreventFix vs.

StandardCustom vs.

TeamIndividual vs.

© 2013 Chris Trimble

OK, so how do you simultaneously:

1) Build something new2) Sustain what exists

© 2013 Chris Trimble 23

© 2013 Chris Trimble

How can I identify the

real innovation heroes

in my organization?

© 2013 Chris Trimble

How can I knock down at

least some of the barriers

that they will face?

© 2013 Chris Trimble 26

© 2013 Chris Trimble

Sure, one person can come up with an idea …

… but can one person EXECUTE?

© 2013 Chris Trimble

It takes a TEAM.

© 2013 Chris Trimble

Not just any team ...

but a team with a very specific structure.

© 2013 Chris Trimble

© 2013 Chris Trimble

The team structure is

a PARTNERSHIP

between a DEDICATED TEAM

and a SHARED STAFF.

© 2013 Chris Trimble

Dedicated Team?

© 2013 Chris Trimble 33

Assigning Innovation as an “Extra” Responsibility

People

Fra

cti

on

of

Tim

e

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 34

Larger Contributions from a Few

People

Fra

cti

on

of

Tim

e

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

Innovation inHealth Care Delivery

generally requires

Innovation in Team Design

© 2013 Chris Trimble

Yes, Dedicated Team!

© 2013 Chris Trimble 37

A Special Kind of Team

PARTNER-SHIP

DedicatedTeam

SharedStaff

© 2013 Chris Trimble 38

You CAN ask the Shared Staff to do MORE work …

But you CANNOT ask the Shared Staff to do DIFFERENT work.

© 2013 Chris Trimble 39

The Shared Staff Can Only Take on Tasks that:

1) Are Familiar or Quickly Learned2) Fit Existing Workflows

3) Fit Existing Roles

© 2013 Chris Trimble 40

A Special Kind of Team

PARTNER-SHIP

DedicatedTeam

SharedStaff

© 2013 Chris Trimble

© 2013 Chris Trimble 42

A Special Kind of Team

PARTNER-SHIP

DedicatedTeam

SharedStaff

© 2013 Chris Trimble 43

Management Structure

Partnership DedicatedTeam

SharedStaff

InnovationLeader

Functional Heads

GeneralManager

SeniorLeader

PerformanceEngine

All OtherPerformance

EngineStaff

© 2013 Chris Trimble 44

The Work of Innovation in Health Care Delivery

1. Define Mission

2. Specify the Work

3. Design the Team

• Divide the Work: Dedicated vs. Shared• What are the roles on the Dedicated Team?• How many are needed in each role?• Who can succeed in each role? • With how much training?

4. Prove it Works: Lower Costs, Better Outcomes

© 2013 Chris Trimble 45

Example: Essentia HealthHeart and Vascular Center

1. Mission: Keep CHF Patients as Healthy as Possible

2. The Work: Patient Engagement, Ensuring Patients Stay on Proper Medications, Regular Contact, Home Health Monitoring (via telescales), Acting on Early Warning Signals of Trouble

3. The Team: Dedicated – 1 NP for every 300 Patients. 1 Nurse supporting 2 NPs. Shared - Cardiologists

4. Results: Lower System Costs, Better Hospital Profits, Better Outcomes for Patients

© 2013 Chris Trimble

Innovation is experimentation

© 2013 Chris Trimble

Running an experiment is easy.

Running a disciplined experiment is hard.

© 2013 Chris Trimble

The Payoff:

If you run a disciplined experiment, you learn as

quickly as possible.

© 2013 Chris Trimble

Learning is a process of making predictions

and then improving them.

© 2013 Chris Trimble 50

Acc

ura

cy o

f Pre

dic

tion

s

Years

Learning

WildGuesses

InformedEstimates

ReliableForecasts

Learning is Making Better Predictions

© 2013 Chris Trimble

Better Predictions

lead to

Better Decisions

which in turn lead to

Better Results

© 2013 Chris Trimble 52

Formalize the Experiment

1. Each innovation initiative needs a separate, stand-alone, custom plan with custom metrics that assess outcomes and cost.

2. Discuss plans, results, and lessons learned in a separate forum.

3. Try to spend a little, learn a lot.

© 2013 Chris Trimble

The Biggest Challenge:

How do you evaluate an innovation leader?

© 2013 Chris Trimble 54

Accountability for LearningNine Evaluation Points

1. Is the innovation leader taking the planning process seriously?

2. Is there a clear hypothesis of record?

3. Does everyone on the team understand the hypothesis?

4. Are the most critical unknowns clear to everyone involved?

5. How has the hypothesis been revised? On the basis of a clearly identified lesson learned or on a whim?

© 2013 Chris Trimble 55

Nine Evaluation Points (cont’d)

6. Is the leader finding a way to spend a little, learn a lot?

7. Has the leader reacted quickly to new information?

8. Is the innovation leader willing to face the facts?

9. Are predictions improving?

© 2013 Chris Trimble

Questions?

© 2013 Chris Trimble

© 2013 Chris Trimble 58

Successful Teams Have:

1. Shared Goals

2. A Clear Structure

3. Mutual Respect & Empathy

© 2013 Chris Trimble

© 2013 Chris Trimble

© 2013 Chris Trimble

Presented by:– Chris Trimble – Professor, Tuck School of

Business at Dartmouth

Leading Innovation in Health Care Delivery

© 2013: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged.