Transcript 10 Rules for Strategic Innovators

Leading
Innovation in
Health Care
Delivery
Presented by:
– Chris Trimble
– Professor, Tuck School of
Business at Dartmouth
© 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
Length & Quality of Life
Role of Innovation in the Biosciences
EXTEND THE CURVE
Per-Capita Health Expenditure
© 2013 Chris Trimble
Length & Quality of Life
Role of Innovation in the Biosciences
EXTEND THE CURVE
Innovation in the
biosciences
Per-Capita Health Expenditure
© 2013 Chris Trimble
Length & Quality of Life
We need a new type of innovation.
Innovation in
health care
delivery
Innovation in the
biosciences
Per-Capita Health Expenditure
© 2013 Chris Trimble
© 2013 Chris Trimble
5
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
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EXECUTION:
the blood, sweat, and tears
of 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.
© 2013 Chris Trimble
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
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13
The EXECUTION challenge:
Tackle two tasks at once –
1) Sustain what exists
2) Build something new
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These two tasks are:
very distinct,
and inevitably in conflict.
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Business Organizations Are Designed to be
Performance Engines
Ongoing Operations
Performance
Engine
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•
•
•
•
•
•
•
•
Today’s Customers
Today’s Competitors
Efficiency
Accountability
On-Spec
On-Budget
On-Time
Profitable
16
Fundamental Incompatibilities
Method of
the Performance
Engine
Realities of
Innovation
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Repeatability
Predictability
Non-Routine
Uncertain
17
Resources for Innovation are Scarce!
Performance
Engine
Innovation
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18
Health Care is Different
Ongoing Operations
American
Health Care
Engine
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•
•
•
•
•
•
•
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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20
Fundamental Incompatibilities:
“Two Canoes”
Volume
vs.
Value
High Tech
vs.
Low Tech
Fix
vs.
Prevent
Custom
vs.
Standard
Individual
vs.
Team
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21
OK, so how do you
simultaneously:
1) Build something new
2) Sustain what exists
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23
How can I identify the
real innovation heroes
in my organization?
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How can I knock down at
least some of the barriers
that they will face?
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26
Sure, one person can come
up with an idea …
… but can one person
EXECUTE?
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It takes a TEAM.
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Not just any team ...
but a team with a
very specific structure.
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© 2013 Chris Trimble
The team structure is
a PARTNERSHIP
between a DEDICATED TEAM
and a SHARED STAFF.
© 2013 Chris Trimble
Dedicated Team?
© 2013 Chris Trimble
Assigning Innovation as an
“Extra” Responsibility
Innovation
100%
Fraction of Time
90%
80%
70%
60%
Ongoing Operations
50%
40%
30%
20%
10%
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
People
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Larger Contributions from a Few
Innovation
100%
Fraction of Time
90%
80%
70%
60%
Ongoing Operations
50%
40%
30%
20%
10%
0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
People
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Innovation in
Health Care Delivery
generally requires
Innovation in
Team Design
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Yes, Dedicated Team!
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A Special Kind of Team
Shared
Staff
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PARTNERSHIP
Dedicated
Team
37
You CAN ask the Shared Staff
to do MORE work …
But you CANNOT ask the
Shared Staff to do DIFFERENT work.
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The Shared Staff Can Only
Take on Tasks that:
1) Are Familiar or Quickly Learned
2) Fit Existing Workflows
3) Fit Existing Roles
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A Special Kind of Team
Shared
Staff
© 2013 Chris Trimble
PARTNERSHIP
Dedicated
Team
40
© 2013 Chris Trimble
A Special Kind of Team
Shared
Staff
© 2013 Chris Trimble
PARTNERSHIP
Dedicated
Team
42
Management Structure
Senior
Leader
Performance
Engine
General
Manager
Innovation
Leader
Functional
Heads
All Other
Performance
Engine
Staff
© 2013 Chris Trimble
Shared
Staff
Partnership
Dedicated
Team
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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 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
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Innovation is
experimentation
© 2013 Chris Trimble
Running an experiment
is easy.
Running a disciplined
experiment is hard.
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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.
© 2013 Chris Trimble
Accuracy of
Predictions
Learning is Making Better Predictions
Wild
Guesses
Informed
Estimates
Reliable
Forecasts
Years
Learning
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Better Predictions
lead to
Better Decisions
which in turn lead to
Better Results
© 2013 Chris Trimble
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.
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The Biggest Challenge:
How do you evaluate an
innovation leader?
© 2013 Chris Trimble
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?
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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?
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Questions?
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© 2013 Chris Trimble
Successful Teams Have:
1. Shared Goals
2. A Clear Structure
3. Mutual Respect & Empathy
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© 2013 Chris Trimble
© 2013 Chris Trimble
Leading
Innovation in
Health Care
Delivery
Presented by:
– Chris Trimble
– Professor, Tuck School of
Business at Dartmouth
© 2013
ChrisChris
Trimble
© 2013:
Trimble. These slides may be freely distributed, with this copyright notice, so long as the format remains unchanged.