Leading Innovation in Health Care Delivery
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1 Leading Innovation in Health Care Delivery Presented by: Chris Trimble Adjunct Professor Dartmouth College 2015: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged Chris Trimble I receive royalties from sales of the above-pictured book. I have no other conflicts of interest to report.
2 Double Win Better Outcomes AND Lower Costs 2015 Chris Trimble 2
3 Penicillin 2015 Chris Trimble 3
4 What if I told you that there is, right in front of us, an entire class of innovations that can deliver double wins? 2015 Chris Trimble 4
5 What if I told you that these innovations were based on familiar, common-sense principles? 2015 Chris Trimble 5
6 What if I told you that these innovations had the potential to reinvigorate the careers of burned out physicians? 2015 Chris Trimble 6
7 What if I told you that these innovations required only modest risks and modest size investments? 2015 Chris Trimble 7
8 What if I told you that such opportunities exist: in every health system, in every medical condition, and in every corner of the country? 2015 Chris Trimble 8
9 What if I told you that we ve been overlooking these innovations, quite literally, for decades? 2015 Chris Trimble 9
10 How is this possible? 2015 Chris Trimble 10
11 How is This Possible? 1. Fee-For-Service Medicine more to come 2015 Chris Trimble 11
12 2013 Chris Trimble
13 What do these innovations look like? 2015 Chris Trimble 13
14 Primary Children s Hospital (Salt Lake City) The Patients Children with Complex Medical Conditions The Innovation More care planning, more care coordination, and more close contact with families. The Results: A Double Win Better Outcomes Fewer Hospitalizations, Fewer ER Visits Higher Satisfaction Costs down >10% Chris Trimble 14
15 Tens of Thousands Of Similar Innovation Initiatives 2015 Chris Trimble 15
16 Small, Full Time*, Clinical Teams For Single, Low-Tech, Initiatives To Redesign Care From Scratch AND Deliver Better Care For A Selected Patient Population 2013 Chris Trimble
17 Small Full Time Clinical Team Redesigns Care Delivers Better Care Particular Patient Population 2015 Chris Trimble
18 2013 Chris Trimble
19 Innovation: The Broad View 2013 Chris Trimble
20 Science? Brand New Ideas? Technology? 2013 Chris Trimble
21 2013 Chris Trimble
22 Outcomes A Cheap and Curative Pill 1940 Cost 2015 Chris Trimble
23 Outcomes Innovation in Aggregate 1940 Cost 2015 Chris Trimble
24 Outcomes Biosciences-Driven Innovations Cost 2015 Chris Trimble
25 Cost Constraint Outcomes The Cost Wall What Now? Biosciences Driven Innovation Cost 2015 Chris Trimble
26 Cost Constraint Outcomes A Second Kind of Innovation 1940 Innovation in Health Care Delivery Biosciences Driven Innovation Cost 2015 Chris Trimble
27 Innovation and the Madness of Fee for Service Payments 1. You get paid ZERO for services you invent 2. You get PENALIZED for keeping patients healthy 2013 Chris Trimble
28 2013 Chris Trimble
29 2015 Chris Trimble 29
30 Innovation is a two-part challenge: IDEAS EXECUTION 2013 Chris Trimble
31 The EXECUTION challenge: Underestimated Underinvested 2013 Chris Trimble
32 An Exception to the Rule IDEAS EXECUTION Biosciences Driven Innovation REALLY HARD HARD Innovation in Health Care Delivery REALLY EASY HARD 2015 Chris Trimble 32
33 Innovation in Health Care Delivery Four Categories, Four Simple Ideas 1. Standardization 2. Coordination 3. Prevention 4. Improved Medical Decisions 2015 Chris Trimble 33
34 How is This Possible? 1. Fee-For-Service Medicine 2. They Seem Kind of Boring 2015 Chris Trimble 34
35 2013 Chris Trimble
36 A Simple Innovation Map Where is the Opportunity? Small Large Improvement Innovation 2015 Chris Trimble
37 Physics of Innovation R tot = R ops + R inn 2013 Chris Trimble
38 Fraction of Time The Critical Resource: TIME 100% 90% 80% 70% 60% 50% 40% Ongoing Operations 30% 20% 10% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% People 2015 Chris Trimble 38
39 Fraction of Time Part Time Contributions from All 100% Innovation 90% 80% 70% 60% 50% 40% Ongoing Operations 30% 20% 10% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% People 2015 Chris Trimble 39
40 The Fundamental Limitation Project Size 2013 Chris Trimble
41 Fraction of Time Innovation Full Time Contribution from a Few 100% 90% 80% 70% 60% 50% Ongoing Operations 40% 30% 20% 10% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% People 2015 Chris Trimble 41
42 Innovation with Full Timers Bigger Projects Resources are More Reliably Available Ability to Practice Clean Slate Team Design (Without Breaking Anything) 2015 Chris Trimble 42
43 Fraction of Time This Approach Does Not Enable Clean Slate Team Design 100% Innovation 90% 80% 70% 60% 50% 40% Ongoing Operations 30% 20% 10% 0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% People 2015 Chris Trimble 43
44 A Simple Innovation Map Where is the Opportunity? Small All, Part Time A Few, Full Time Large 2015 Chris Trimble
45 A Lab or Innovation Center May Not Be the Answer 2013 Chris Trimble
46 Team Redesign lies at the very core of innovation in health care delivery Chris Trimble
47 Team Based Medicine Step One: Build New Teams From Scratch 2013 Chris Trimble
48 A Simple Innovation Map Where is the Opportunity? Small Comfort Zone Large Bright, Shiny, and New 2015 Chris Trimble
49 How is This Possible? 1. Fee-For-Service Medicine 2. They Seem Kind of Boring 3. They Fall Into A Giant Hole in Innovation Investment Patterns 2015 Chris Trimble 49
50 2013 Chris Trimble
51 Innovation: The Broad View 2013 Chris Trimble
52 Science? Brand New Ideas? Technology? 2013 Chris Trimble
53 2013 Chris Trimble None of the above!
54 2013 Chris Trimble
55 Small Full Time Clinical Team Redesigns Care Delivers Better Care Particular Patient Population 2015 Chris Trimble
56 Providence Health & Services Portland, OR The Population Frail and homebound elders The Intervention Appointments in the patient s residence. Care planning, care coordination, decision support. 24x7 nursing availability. Anticipated Results: A Double Win Avoidance of unwanted and unneeded care. Savings > 2-3x investment in additional care Chris Trimble 56
57 2013 Chris Trimble
58 What Innovation Leaders Do 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 2015 Chris Trimble 58
59 Tens of Thousands Of Innovation Initiatives Tens of Thousands Of Physician Innovators 2015 Chris Trimble 59
60 Action Steps for Senior Leaders 1. Accelerate Payment Reform 2. Invest in Innovation in Health Care Delivery 3. Do Not Invest in a Big Idea Hunt. (Simple Ideas Will Do.) 4. Invest in Small Full-Time Clinical Teams that Redesign and Deliver Better Care for Particular Patient Populations 5. Recruit Physician Innovators 6. Spread Success Stories 2015 Chris Trimble 60
61 2013 Chris Trimble Questions
62 2013 Chris Trimble
63 2013 Chris Trimble
64 Leading Innovation in Health Care Delivery Presented by: Chris Trimble Adjunct Professor Dartmouth College 2015: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged Chris Trimble I receive royalties from sales of the above-pictured book. I have no other conflicts of interest to report.
Leading Innovation in Health Care Delivery
Leading Innovation in Health Care Delivery Presented by: Chris Trimble Adjunct Professor Dartmouth College 2015: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long
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