At the Crossroad of Innovation & Operations

How can healthcare organizations best innovate in the swell of industry change?

authors Lynne Jeter

Chris Trimble is on a mission. A Dartmouth adjunct professor for the Master in Health Care Delivery Science and MBA programs, Trimble is well-known for his expertise on innovation inside established organizations. He’s traveled the world speaking to organizations ranging from healthcare systems to Fortune 500 companies that touch on healthcare, like General Electric.

Trimble, co-author of the New York Times bestseller Beyond the Idea: How to Execute Innovation in any Organization (AAPL, 2013), and more recently his sixth book, How Physicians Can Fix Health Care: One Innovation at a Time (AAPL, 2015), spoke with Medical News about resource allocation, key steps to take, opportunities to seek, pitfalls to avoid, and why full-time transition teams are necessary.

Medical News: Taking a clue from your book, How Physicians Can Fix Health Care, what major aspects of healthcare need fixing?

Trimble: So many. We focus on care redesign, changing the care model, and innovation initiatives that take the form of small, but full-time teams that redesign care for a very particular patient population.

For senior executives in particular, innovation resources are being allocated in a way that overlooks a huge area of opportunity. And I'd like to describe that a little bit, because there’s a pretty solid history of investment in quality improvement work in healthcare systems. That's all very good, but quality improvement work tends to constitute initiatives that can be squeezed into people's slack time on the job, and also into their existing job descriptions.

On the other end of the spectrum, we're investing in high-tech innovations – new cell phone apps to improve health, new wearable devices. It's fun to be on the cutting edge, but a whole category is sort of in the middle. And in the middle, we're typically working with common sense, very straightforward ideas, like doing a better job of coordinating care, keeping high-risk patients healthy, or helping patients consider consequential medical decisions very carefully.

It’s best done beyond the reach of quality improvement programs and specifically by commissioning small but full-time teams of three or four people to improve care for a very particular patient population. That full-time piece is so critical.

Medical News: Businesses are designed for ongoing operations, not necessarily innovation, which exposes deep, fundamental conflicts between the two. Tell us about the complexities of originating and managing these teams inside established organizations.

Trimble: It’s difficult because those teams are inevitably going to experience conflict with existing ways of doing business. And yet, to get anything done, they can't really isolate themselves. They have to engage. There are always people involved in the initiative part-time with supporting roles so there must be a healthy relationship between those working on the initiative full-time and the supporting cast. It’s a delicate balance that's tricky and counterintuitive. The core of my latest book is a step-by-step guide for physician leaders of these initiatives so they may avoid many mistakes their peers made in other organizations.

Medical News: Have you come across any sort of formula that gives a good ratio of number of people needed on a full-time team to the number of patients the organization has under its care?

Trimble: Wouldn't it be nice if there was such a guideline? But there's not because it depends so heavily on the type of patient population. For example, what about children with complex medical conditions, their families and families’ needs? In that case, it was a full-time team of four that served 600 families.

On the other end of the spectrum, we have examples of initiatives to maximize the throughput and to maximize the providers’ delivery of services. The best example is the high volume joint replacement center where the idea, again, is just the opposite: to spend as little time on each patient as possible in a way consistent with high quality.

Medical News: Physicians seem to have been taken out of the equation for providing input into these decisions. Tell me what you see as their place in innovating these teams and innovating an organization.

Trimble: The physician’s role is so crucial. In the past, under fee-for-service, it’s been nearly impossible to do with a pitiful few exceptions where the incentives just happen to work for a variety of quirky reasons. By and large, the fee-for-service stands in the way of the kind of work we're discussing.

The most powerful reason to feel optimistic about the future of healthcare in the United States is the steady transition to accountable care and value-based payments. There’s no going back. While physicians initially may be anxious about the fee-for-service transition to accountable care, they’ll find it’s also extremely liberating. Once fully implemented under accountable care, fee-for-service payers won’t be telling physicians what they can and cannot do, how much time they may spend with each patient, or what they can and cannot bill for. Instead, payers are saying: send us the results. If they’re good and costs are low, we’ll reward you financially. That's the way it should be.

Medical News: Are you encouraged by the number of ACOs that have been growing the last few years?

Trimble: Yes. In a couple of isolated cases, people have lost money by perhaps being a little bit too aggressive too quickly. But the overall trend seems very positive, and I'm very encouraged by the targets that CMS has set about the number of patients that will be under some sort of value-based payment by 2018. It bodes extremely well for U.S. healthcare.


American Association for Physician Leadership

Chris Trimble

More in Business

Business  May 04

New Reimbursement Models

Behavioral health parity is the goal, says leading industry specialist.

Business  May 04

Reimbursement Parity for Behavioral Health

This payment specialist says reimbursement reform has been slow, but signs point to change starting to come more quickly.

Business  Apr 07

Planning for Long-Term Care

“A man who procrastinates in his choosing will inevitably have his choice made for him by circumstance.” – Hunter S. Thompson

Business  Feb 29

‘Trigger Tool’ Available for Hospitals and SNFs

How can ‘trigger tools’ identify adverse events?

Business  Feb 29

Staffing Predicaments of Full Open Enrollment

How will staffing change with full open enrollment?

Business  Feb 08

Challenging Population Health Management Issues

The nation’s leading forum on innovations in population health is slated for March 7-9 in Philadelphia.

Regulatory / Compliance  Feb 08

RAC is Back

After a pause in the action while CMS tweaked the RAC program and began the interview process for new auditors, RACs are back … with…

Clinical  Feb 08

The 7th Character

How important is the 7th character for Medicare/Medicaid claims?

Business  Jan 26

Taken for Granted: A New Era in Care – the New SSM Health Saint Louis University Hospital

Patient-centered design will enhance the new state-of-the-art academic facilities.

Clinical  Jan 26

New Outpatient Care Center Under Construction in South St. Louis County

Washington University School of Medicine in St. Louis and Barnes-Jewish Hospital (BJH) are building a new outpatient facility in south…

Business  Jan 19

From Medicine to the Business World

Hospitalist, intensivist and entrepreneur relishes helping other women succeed.

Business  Jan 15

Cybersecurity and Healthcare

The NIST Cybersecurity Framework is aimed at protecting the nation’s data.

Business  Jan 15

Washington University Alumni Have Human Periscope at Events

Washington University alumni now have a new proxy at St. Louis business mixers.

Business  Jan 15

Midwest Healthcare Leaders Converge To Discuss Cutting-Edge Innovation

Physicians, investors and entrepreneurs directly exchange ideas at unique business mixer in heart of America.

Business  Jan 06

Evidence-based Design: Marrying Form & Function on the Front Line

Evidence-based design experts know that outfitting healthcare facilities is about much more than just selecting attractive furnishings…

Business  Dec 15

Chef’s New Cookbook Helps Chemotherapy Patients Eat Their Way Through Treatment

Cook identifies what to adjust to make flavorful food for cancer patients.

Business  Dec 15

Taken for Granted: A Journey Through St. Louis Healthcare

In a city of world renowned healthcare, expansion is moving rapidly.

Business  Dec 14

No Correlation Found Between Length of ER Stay and Mortality Rates

How much does ER and ED overcrowding affect trauma patient care?

Business  Dec 11

Retirement Funding Strategies for High Income Earners

All retirement plans are not created equal. High income earners have to do a little homework to find the best solution to maximize…

Business  Dec 11

MGMA Conference Tackled Evolving Practice Needs

The recent MGMA annual meeting in Nashville proved there’s no room for ‘business as usual’ in today’s evolving healthcare…

Clinical  Dec 11

New Amniotic Allograft Storage Breakthrough Enriches Healing Potential

Advanced stem cell preservation is giving researchers and physicians multiple options.

  Load more content