1. © 2013 Chris Trimble Presented by: Chris Trimble Adjunct Professor Dartmouth College Leading Innovation in Health Care Delivery © 2015: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged. I receive royalties from sales of the above-pictured book. I have no other conflicts of interest to report.

2. © 2015 Chris Trimble

3. Who invited this guy?

4. © 2015 Chris Trimble 4 Agenda The Cheap and Curative Pill Bright and Shiny New Objects The Prescription The Happiest Physicians

5. © 2015 Chris Trimble 5 The Cheap and Curative Pill

6. © 2015 Chris Trimble Cost Outcomes A Cheap and Curative Pill 1940

7. © 2015 Chris Trimble Cost Outcomes Innovation in Aggregate 1940

8. © 2015 Chris Trimble Cost Outcomes Biosciences-Driven Innovations 1940 1990 1970 1960 1980 2000 1950 2010

9. © 2015 Chris Trimble Cost Outcomes 1940 1990 1970 1960 1980 2000 1950 2010 Biosciences Driven Innovation Cost Constraint The Cost Wall What Now?

10. © 2015 Chris Trimble Cost Outcomes 1940 1990 1970 1960 1980 2000 1950 2010 Biosciences Driven Innovation Cost Constraint A Second Kind of Innovation Innovation in Health Care Delivery

11. © 2015 Chris Trimble 11 Bright and Shiny New Objects

12. © 2015 Chris Trimble 12

13. © 2013 Chris Trimble Innovation is a two-part challenge: IDEAS EXECUTION

14. © 2013 Chris Trimble The EXECUTION challenge: Underestimated Underinvested

15. © 2015 Chris Trimble 15 An Exception to the Rule IDEASEXECUTION Biosciences Driven Innovation REALLY HARD HARD Innovation in Health Care Delivery REALLY EASY HARD

16. © 2015 Chris Trimble 16 Innovation in Health Care Delivery Four Categories, Four Simple Ideas 1.Standardization 2.Coordination 3.Prevention 4.Improved Medical Decisions

17. © 2015 Chris Trimble A Simple Innovation Map Where is the Opportunity? Large Small InnovationImprovement

18. © 2013 Chris Trimble Physics of Innovation R tot = R ops + R inn

19. © 2015 Chris Trimble 19 The Critical Resource: TIME 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%

20. © 2015 Chris Trimble 20 Part Time Contributions from All 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

21. © 2013 Chris Trimble The Fundamental Limitation Project Size

22. © 2015 Chris Trimble 22 Full Time Contribution 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

23. © 2015 Chris Trimble 23 Innovation with Full Timers Bigger Projects Resources are More Reliably Available Ability to Practice Clean Slate Team Design (Without Breaking Anything)

24. © 2015 Chris Trimble 24 This Approach Does Not Enable Clean Slate Team Design 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

25. © 2015 Chris Trimble Large Small All, Part Time A Few, Full Time A Simple Innovation Map Where is the Opportunity?

26. © 2013 Chris Trimble A “Lab” or “Innovation Center” May Not Be the Answer

27. © 2013 Chris Trimble Team Redesign … …lies at the very core of innovation in health care delivery.

28. © 2013 Chris Trimble Team Based Medicine Step One: Build New Teams From Scratch

29. © 2015 Chris Trimble A Simple Innovation Map Where is the Opportunity? Large Small Bright, Shiny, and New Comfort Zone

30. © 2015 Chris Trimble 30 The Prescription

31. © 2015 Chris Trimble 31 Primary Children’s Hospital (Salt Lake City) 1. The Population Children with Complex Medical Conditions. 2. The Intervention Heavyweight Primary Care. More care planning, care coordination, and close contact with families. 3. Results Outcomes up. Costs down >10%. Patients more satisfied.

32. © 2015 Chris Trimble 32 The Prescription: 1.Accelerate the transition to value-based payments. 2.Make more bets on full time teams.

33. © 2013 Chris Trimble The Happiest Physicians

34. © 2015 Chris Trimble 34 Physician Innovators 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

35. © 2013 Chris Trimble Greater Autonomy Plus Greater Accountability

36. © 2013 Chris Trimble Questions

37. © 2015 Chris Trimble 37 Team Design Innovation in Established Organizations PARTNER- SHIP Dedicated Team Shared Staff

38. © 2013 Chris Trimble

39. www.physicianinnovators.net

40. © 2015 Chris Trimble

41. © 2013 Chris Trimble Presented by: Chris Trimble Adjunct Professor Dartmouth College Leading Innovation in Health Care Delivery © 2015: Chris Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged. I receive royalties from sales of the above-pictured book. I have no other conflicts of interest to report.