© 2013 Chris Trimble Presented by: – Chris Trimble – Professor, Tuck School of Business at...

© 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.


Per-Capita Health Expenditure

Len

gth

& Q

uality

of

Lif

e

Role of Innovation in the BiosciencesEXTEND THE CURVE



Len

gth

& Q

uality

of

Lif

e

Role of Innovation in the BiosciencesEXTEND THE CURVE

Innovation in the biosciences



Len

gth

& Q

uality

of

Lif

eWe need a new type of innovation.

Innovation in the biosciences

Innovation in health care

delivery


Innovation is a two-part challenge:

IDEAS

EXECUTION


These two parts of the challenge …

… have almost nothing to do with each other


IDEAS:

invention, creativity, brainstorming, serendipity,

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


EXECUTION:

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


Oh, by the way …

…you must succeed at both to win.


The EXECUTION challenge is a lot harder than (most)

people imagine.


Innovation in Health Care Delivery:

The Ideas are Simple;The Implementation is Hard


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


The EXECUTION challenge:

Tackle two tasks at once –

1) Sustain what exists 2) Build something new


These two tasks are:

very distinct,

and inevitably in conflict.


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


Fundamental Incompatibilities

PredictabilityRepeatabilityMethod ofthe PerformanceEngine

UncertainNon-RoutineRealities of Innovation


Resources for Innovation are Scarce!

PerformanceEngine

Innovation

18


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


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)


Fundamental Incompatibilities:“Two Canoes”

ValueVolume vs.

Low TechHigh Tech vs.

PreventFix vs.

StandardCustom vs.

TeamIndividual vs.


OK, so how do you simultaneously:

1) Build something new2) Sustain what exists


How can I identify the

real innovation heroes

in my organization?


How can I knock down at

least some of the barriers

that they will face?


Sure, one person can come up with an idea …

… but can one person EXECUTE?


It takes a TEAM.


Not just any team ...

but a team with a very specific structure.


The team structure is

a PARTNERSHIP

between a DEDICATED TEAM

and a SHARED STAFF.


Dedicated Team?


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


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


Innovation inHealth Care Delivery

generally requires

Innovation in Team Design


Yes, Dedicated Team!


A Special Kind of Team

PARTNER-SHIP

DedicatedTeam

SharedStaff


You CAN ask the Shared Staff to do MORE work …

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


The Shared Staff Can Only Take on Tasks that:

1) Are Familiar or Quickly Learned2) Fit Existing Workflows

3) Fit Existing Roles



PARTNER-SHIP

DedicatedTeam

SharedStaff


Management Structure

Partnership DedicatedTeam

SharedStaff

InnovationLeader

Functional Heads

GeneralManager

SeniorLeader

PerformanceEngine

All OtherPerformance

EngineStaff


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


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


Innovation is experimentation


Running an experiment is easy.

Running a disciplined experiment is hard.


The Payoff:

If you run a disciplined experiment, you learn as

quickly as possible.


Learning is a process of making predictions

and then improving them.


Acc

ura

cy o

f Pre

dic

tion

s

Years

Learning

WildGuesses

InformedEstimates

ReliableForecasts

Learning is Making Better Predictions


Better Predictions

lead to

Better Decisions

which in turn lead to

Better Results


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.


The Biggest Challenge:

How do you evaluate an innovation leader?


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?


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?


Questions?


Successful Teams Have:

1. Shared Goals

2. A Clear Structure

3. Mutual Respect & Empathy


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.

© 2013 Chris Trimble Presented by: – Chris Trimble – Professor, Tuck School of Business at...

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