© 2013 Chris Trimble Presented by: Chris Trimble Adjunct Professor Dartmouth College Leading...

© 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.


Who invited this guy?

© 2015 Chris Trimble 4

Agenda

• The Cheap and Curative Pill

• Bright and Shiny New Objects

• The Prescription

• The Happiest Physicians


The Cheap and Curative Pill


Cost

Out

com

esA Cheap and Curative Pill

1940


Cost

Out

com

esInnovation in Aggregate

1940


Cost

Out

com

esBiosciences-Driven Innovations

1940

1990

19701960

19802000

1950

2010


Cost

Out

com

es

1940

1990

19701960

19802000

1950

2010

Biosciences

DrivenInnovation

Cost

Co

nstr

aint

The Cost WallWhat Now?


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


Bright and Shiny New Objects


Innovation is a two-part challenge:

IDEASEXECUTION


The EXECUTION challenge:UnderestimatedUnderinvested


An Exception to the Rule

IDEAS EXECUTION

BiosciencesDriven

InnovationREALLYHARD HARD

Innovation in Health Care

DeliveryREALLYEASY HARD


Innovation in Health Care DeliveryFour Categories, Four Simple Ideas

1. Standardization

2. Coordination

3. Prevention

4. Improved Medical Decisions


A Simple Innovation MapWhere is the Opportunity?

LargeSmall

InnovationImprovement


Physics of Innovation

Rtot = Rops + Rinn


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%


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


The Fundamental LimitationProject Size


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


Innovation with Full Timers

• Bigger Projects

• Resources are More Reliably Available

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


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


LargeSmallAll,

Part Time

A Few,Full

Time



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


Team Redesign …

…lies at the very core of innovation in

health care delivery.


Team Based Medicine

Step One:Build New Teams

From Scratch



Large SmallBright, Shiny,

and New Comfort

Zone


The Prescription


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.


The Prescription:

1. Accelerate the transition to value-based payments.

2. Make more bets on full time teams.


The Happiest Physicians


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


Greater Autonomy

Plus

Greater Accountability


Questions


Team DesignInnovation in Established Organizations

PARTNER-SHIP

DedicatedTeam

SharedStaff


www.physicianinnovators.net


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.

© 2013 Chris Trimble Presented by: Chris Trimble Adjunct Professor Dartmouth College Leading...

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