1. © 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. I have no conflicts of interest to report.

2. © 2013 Chris Trimble Per-Capita Health Expenditure Length & Quality of Life Role of Innovation in the Biosciences EXTEND THE CURVE

3. © 2013 Chris Trimble Per-Capita Health Expenditure Length & Quality of Life Role of Innovation in the Biosciences EXTEND THE CURVE Innovation in the biosciences

4. © 2013 Chris Trimble Per-Capita Health Expenditure Length & Quality of Life We need a new type of innovation. Innovation in the biosciences Innovation in health care delivery

5. © 2013 Chris Trimble 5

6. Innovation is a two-part challenge: IDEAS EXECUTION

7. © 2013 Chris Trimble These two parts of the challenge … … have almost nothing to do with each other

8. © 2013 Chris Trimble IDEAS: invention, creativity, brainstorming, serendipity, out-of-the-box-thinking, science, technology, strategy, disrupting your competition

9. © 2013 Chris Trimble EXECUTION: the blood, sweat, and tears of getting the work done.

10. © 2013 Chris Trimble Oh, by the way … …you must succeed at both to win.

11. © 2013 Chris Trimble The EXECUTION challenge is a lot harder than (most) people imagine.

12. © 2013 Chris Trimble 12 Innovation in Health Care Delivery: The Ideas are Simple; The Implementation is Hard

13. © 2013 Chris Trimble 13 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

14. © 2013 Chris Trimble The EXECUTION challenge: Tackle two tasks at once – 1) Sustain what exists 2) Build something new

15. © 2013 Chris Trimble These two tasks are: very distinct, and inevitably in conflict.

16. © 2013 Chris Trimble 16 Business Organizations Are Designed to be Performance Engines Performance Engine Ongoing Operations Today’s Customers Today’s Competitors Efficiency Accountability On-Spec On-Budget On-Time Profitable

17. © 2013 Chris Trimble 17 Fundamental Incompatibilities PredictabilityRepeatability Method of the Performance Engine UncertainNon-Routine Realities of Innovation

18. © 2013 Chris Trimble Resources for Innovation are Scarce! 18

19. © 2013 Chris Trimble 19 Health Care is Different American Health 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

20. © 2013 Chris Trimble 20 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)

21. © 2013 Chris Trimble 21 Fundamental Incompatibilities: “Two Canoes” ValueVolumevs. Low TechHigh Techvs. PreventFixvs. Standard Custom vs. TeamIndividualvs.

22. © 2013 Chris Trimble OK, so how do you simultaneously: 1) Build something new 2) Sustain what exists

23. © 2013 Chris Trimble 23

24. © 2013 Chris Trimble How can I identify the real innovation heroes in my organization?

25. © 2013 Chris Trimble How can I knock down at least some of the barriers that they will face?

26. © 2013 Chris Trimble 26

27. © 2013 Chris Trimble Sure, one person can come up with an idea … … but can one person EXECUTE?

28. © 2013 Chris Trimble It takes a TEAM.

29. © 2013 Chris Trimble Not just any team... but a team with a very specific structure.

30. © 2013 Chris Trimble

31. The team structure is a PARTNERSHIP between a DEDICATED TEAM and a SHARED STAFF.

32. © 2013 Chris Trimble Dedicated Team?

33. © 2013 Chris Trimble 33 Assigning Innovation as an “Extra” Responsibility People Fraction of Time 10% 80% 90% 70% 60% 40% 50% 30% 20% 100% Ongoing Operations 0% 10% 20% 30%40% 50% 60%70% 80% 90% 100% Innovation

34. © 2013 Chris Trimble 34 Larger Contributions from a Few People Fraction of Time 10% 80% 90% 70% 60% 40% 50% 30% 20% 100% Ongoing Operations 0% 10% 20% 30%40% 50% 60%70% 80% 90% 100% Innovation

35. © 2013 Chris Trimble Innovation in Health Care Delivery generally requires Innovation in Team Design

36. © 2013 Chris Trimble Yes, Dedicated Team!

37. © 2013 Chris Trimble 37 A Special Kind of Team PARTNER- SHIP Dedicated Team Shared Staff

38. © 2013 Chris Trimble 38 You CAN ask the Shared Staff to do MORE work … But you CANNOT ask the Shared Staff to do DIFFERENT work.

39. © 2013 Chris Trimble 39 The Shared Staff Can Only Take on Tasks that: 1) Are Familiar or Quickly Learned 2) Fit Existing Workflows 3) Fit Existing Roles

40. © 2013 Chris Trimble 40 A Special Kind of Team PARTNER- SHIP Dedicated Team Shared Staff

41. © 2013 Chris Trimble

42. 42 A Special Kind of Team PARTNER- SHIP Dedicated Team Shared Staff

43. © 2013 Chris Trimble 43 Management Structure Partnership Dedicated Team Shared Staff Innovation Leader Functional Heads General Manager Senior Leader Performance Engine All Other Performance Engine Staff

44. © 2013 Chris Trimble 44 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

45. © 2013 Chris Trimble 45 Example: Essentia Health Heart 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

46. © 2013 Chris Trimble Innovation is experimentation

47. © 2013 Chris Trimble Running an experiment is easy. Running a disciplined experiment is hard.

48. © 2013 Chris Trimble The Payoff: If you run a disciplined experiment, you learn as quickly as possible.

49. © 2013 Chris Trimble Learning is a process of making predictions and then improving them.

50. © 2013 Chris Trimble 50 Accuracy of Predictions Years Learning Wild Guesses Informed Estimates Reliable Forecasts Learning is Making Better Predictions

51. © 2013 Chris Trimble Better Predictions lead to Better Decisions which in turn lead to Better Results

52. © 2013 Chris Trimble 52 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.

53. © 2013 Chris Trimble The Biggest Challenge: How do you evaluate an innovation leader?

54. © 2013 Chris Trimble 54 Accountability for Learning Nine 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?

55. © 2013 Chris Trimble 55 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?

56. © 2013 Chris Trimble Questions?

57. © 2013 Chris Trimble

58. 58 Successful Teams Have: 1. Shared Goals 2. A Clear Structure 3. Mutual Respect & Empathy

59. © 2013 Chris Trimble

61. 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.