© 2013 chris trimble presented by: – chris trimble – professor, tuck school of business at...
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© 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
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© 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.
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Innovation in Health Care Delivery:
The Ideas are Simple;The Implementation is Hard
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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.
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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
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Fundamental Incompatibilities
PredictabilityRepeatabilityMethod ofthe PerformanceEngine
UncertainNon-RoutineRealities of Innovation
© 2013 Chris Trimble
Resources for Innovation are Scarce!
PerformanceEngine
Innovation
18
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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
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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)
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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
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© 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?
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© 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?
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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
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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!
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A Special Kind of Team
PARTNER-SHIP
DedicatedTeam
SharedStaff
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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
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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
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Management Structure
Partnership DedicatedTeam
SharedStaff
InnovationLeader
Functional Heads
GeneralManager
SeniorLeader
PerformanceEngine
All OtherPerformance
EngineStaff
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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
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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.
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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
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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?
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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?
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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
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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.