Leading Innovation in Health Care Delivery

Transcription

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

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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

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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

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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.