Chris Trimble, Author of How Physicians Can Fix Health Care: One Innovation at a Time

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

Mark Masselli: This is Conversations on Healthcare , I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well Margaret , we are in the season of giving thanks and it seems with
so much going on in the world , we have much to be truly thankful for here in our
country.

Margaret Flinter: Well we do indeed Mark , b ut our hearts go out to the victims of the
Paris attacks as well as all of those refugees in search of a place to call home. I think it
adds a special [inaudible 0:28 ] Ame rican families gather safely around their holiday
tables during this holiday season to think about so many that don’t have a home.

Mark Masselli: Absolutely , a nd meanwhile the S urgeon G eneral in The Department of
Health and Human Services want to remind folks that Thanksgiving is also National
Family History Day, a great time to collect the families’ health history.

Margaret Flinter: Well you know a recent survey show that while most Americans
believe it's important to know your family hi story, only about a third of Americans
actually do , a nd for many families it's just never occurred to them to ask about past
generations of loved ones and what health issues might have befallen them.

Mark Masselli: There is actually a guide you can downlo ad from the Department of
Health and Human Services website. Just go to a familyhistory.hhs.org , a simple
template is provided to guide families through the process of collecting that family health
history and making it available to future generation , s o pass the cranberries and also
[inaudible 1:24 ] .

Margaret Flinter: If you go a long way in helping families and especially the younger
generations understand what health risks they might face down the line and also how to
make better use of preventive meas ures and screenings to reduce risk and improve
their own health in future.

Mark Masselli: The future of healthcare is on the mind of our guest today , Chris Trimble
is an expert in organizational innovation ; he has since turned his attention to innovation
in the healthcare industry.

Margaret Flinter: Chris will be talking about his most recent book, How Physicians Can
Fix Healthcare – One Innovation at a Time.

Mark Masselli: Lori Robertson stops by, the managing editor of FactCheck.org , is
always on the hunt for misstatements spoken about health policy in the public domain.

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

Margaret Flinter: And no matter what the topic , you can hear all of our shows by going
to chcradio.com.

Mark Masselli: And as always if you have comments , please email us at
[email protected] or find us on Facebook or Twitter ; we love hearing from you.

Margaret Flinter: We will get to our interview with Chris Trimble in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

(Music)

Marianne O'Hare: I'm Marianne O'Hare with these healthcare headlines. Men’s health
and c ancer screenings, prostate screenings are down and so is cancer detection. The
US Preventive Services Task Force recommended in 2012 and regular screening for
heightened PSA levels in men , saying at the time the risks outweighed the benefits of
the blood test. The theory behind the recommendation is that prostate cancers grow
very slowly and might never harm the patient , but all are treated a nd often with rigorous
and life - altering treatments, exposing too many men they say to radiation and
incontinence a nd other side effects.

Experts in urology fear that pendulum is swung too far in the wrong direction and not
enough screenings are being ordered now. There has been 7% drop in just a couple of
years in the numbers of men over 50 being given those routine screenings and
diagnos e s are down by tens of thousands of patients. With actor Charlie Sheen’s
recent disclosure that he was HIV positive , it has put the disease on the front burner as
we approach World AIDS Day. While HIV has become a disease of medical
management , there is far less fear in certain populations and there are still some 50,000
new diagnos e s each year , especially among young men of color .

Meanwhile HIV positive folks who purchase the most popular silver plans on the federal
insurance marketplaces are finding it harder to access the drugs required to hold the
disease in check . I n 31 states and District of Columbia out - of - pocke t cost for
purchasing these drugs can run into the thousands. Meanwhile the cost of drugs is
increasingly driving the cost of overall health in this country . T here is also a global
impact . A survey shows by the year 2020 , the world will spend a trillion and a half
dollars on prescription drugs . I n 2015 , the number was just over a trillion dollars.

Texas has been hard at work trying to shut down Planned Parenthood ; the only access
to family planning and basic health services for hundreds of thousands of mostly poor
women and that limited access is having an ancillary effect. An estimated 240,000

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

Texas women have resorted to attempting self - induced abortions . H ealt h officials warn
this is a crisis in the making. I am Marianne O'Hare with these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Chris Trimble, author of How Physicians
Can Fix Healthcare – One Innovation at a Time. Mr. Trimble i s an expert on innovation
within established organizations with a more recent focus on healthcare industry. He is
a professor in the Masters in Healthcare Delivery Science Program at Dartmouth ’s Tuck
School of Business and he has advised a number of Fortu ne 100 companies on the
innovation strategies including Microsoft, AT&T , and GE. A prolific writer , Mr. Trimble
also co - wrote Beyond the Idea: How to Execute Innovation in any Organization as well
as The McKinsey Award winning Stop the Innovation Wars in the Harvard Business
Review. He served as a Nuclear Submarine Officer in the US Navy, earned his
Bachelors of Science and Mechanical Engineering at the University of Virginia and his
MBA at the Tuck School of Business at Dartmouth. Mr. Trimble welcome to
Conversations on Healthcare.

Chris Trimble: Thanks very much Mark . It's great to be here .

Mark Masselli: Love the line in the book about your ability to walk through a submarine
blindfolded and be able to just sort of do anything. Now you have been re ally engaged
in innovation ; you know it's a challenge for any organization; how do you innovate,
continue to serve your customer base , and keep their businesses moving forward and
you have been looking also at large organizations as we just said GE, Micros oft , and
eBay , b ut now you have start ing to make the shift over to healthcare with the Affordable
Care Act and just changes in the business climate going through enormous policy and
care delivery side change , so a great time to bring skill sets around the innovation. Can
you describe for our listeners your focus on healthcare and how your innovation
principles were adapted to fit to the unique challenges in the industry?

Chris Trimble: I sure can Mark , you know you described what I h ave been doing very
well . I have been studying for many , many years why it's so hard for organizations to
innovate , and it's because there is so much conflict between what already exists on -
going operations and innovation and that much is the same in the industry as it is in
healthcare. I have been looking for an opportunity . I had to really dig my teeth into an
issue of social significance where innovation was going to play a big role and so
healthcare just called out to me that way as the perfect chanc e.

So I would say when I first came into it , I probably I underestimated just how
complicated and unusual how peculiar an industry it is and so it did take some time and
some effort to figure out how to customize what I had developed for any industry to th e

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

specific challenges of healthcare , but I just found out I loved the challenge of getting to
know a profession I have long admired, the medical profession , and learned how to
work with and communicate with physicians in particular and hopefully provide some
helpful guide post towards making innovation happen.

Margaret Flinter: Well Chris you know in your book you made a great observation that
when penicilli n was discovered it delivered a double win for the healthcare industry. We
had not only a vastly improved chance of survival of infection so much better health
outcomes , but you have made the observation now that the 21st century double win
isn’t going to come from a pill or a device but will come from breakthroughs in care
delivery innovation maybe through what we call implementation science here in our
organization . You have also said you see reverse innovation playing a great role . T ell
us what you me an by that and maybe give us some examples ; what are these double
wins of the 21st century that we are likely to see?

Chris Trimble: There may still be double wins where we get both an increase in
outcomes and a decrease in cost from the same medical inno vation , but it's pretty clear
that if you look at innovation or biosciences driven innovation in aggregate, the curve is
flattened out , which is to say we are spending a lot more and the gains are getting ever
more marginal ; l ike at the most everyone can t hink of at least one recently released
pharmaceutical that is only marginally better than its predecessor and yet cost s far
more. These double wins in the biosciences are very rare , and we shouldn't feel badly
about that . E very industry you will ever loo k at , this is well documented . T he innovation
trajectories tend to get flatter over time a nd what that means is we have to look in an
entirely new area for double wins and that new area is innovation in healthcare delivery.
This is a pretty unique opportunity in healthcare . T here are opportunities for double
wins all over the country and in e very medical condition and yet we have been sitting on
these for decades in part because we are very understandably obsessed with advances
in the biosciences.

But also because of fee for service medicines, fee for service medicine stands in the
way the maj ority of the time of innovations in healthcare delivery and so we have been
missing these opportunities for a long , long time and there is no greater reason to feel
optimistic about the future of healthcare in the steady and even accelerating transition
we are making to accountable care and a value base d payment. T his will open the door
for innovation in healthcare delivery as never before.

The only question is would we recognize it as innovation . V ery often these innovations
are based on common sense principles that we talk about a lot , like coordination of care
or better prevention for populations that are at high risk , a nd they may not represent
intellectual breakthroughs but they do deliver that dramatic double win , s o to finish your

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

question you as ked about reverse innovation and this refers to innovation in the
developing world and the increasing prevalence of innovations that are adopted first in
the developing world , a nd we are seeing that in all industries I think sort of underlying
forces very easy to grasp . H ere in the United States, we need to find ways to deliver
higher quality care at lower cost why wouldn’t we look for inspiration to nations around
the world that have struggled with minimal resources for decades.

Mark Masselli: Chris , I r eally liked your mountain climbing analogy when referring to
innovation of any kind and you said that amateur innovators cheer when they get to the
top of the mountain and when the experience d innovator knows to wait until they have
gotten back down . T alk to our listeners about the cycle of organizational innovation and
where the pitfalls are generally lurking in the process of not only innovation but
implementation of these new ideas.

Chris Trimble: Innovation is like that and the summit moment is that moment when you
come up with the new idea , and unfortunately when organizations get excited about
innovation , they tend to imagine that if they can just come up with that breakthrough
new idea , the rest will be a snap. More often than not t hat is just wrong . T he idea is the
easy part and that’s particularly true for innovation in healthcare delivery because we
are talking about ideas that have been around for a long time like standardization of
care processes or coordination of care . T hese are not complicated ideas and at least
they are just ideas that we have s a t on .

Margaret Flinter: Actually the pace of innovation has been accelerating b ut the purpose
of your book is that clinicians innovating on the front lines of care delivery that th ey all
hold a key or part of the key to meaningfully transforming healthcare. Tell us how
clinician s should be thinking about fostering innovation . T ell us why appointing a
designated team is an essential first step.

Chris Trimble: One of the themes of the book is that there are a whole lot of even near
at hand innovations that we have not capitalized on that are lower risk , have a higher
probability of payoff ; w ouldn’ t be a shame if we have got so absorbed and the
possibilities of new technology that we overlooked the lower hanging fruit . Y ou are
absolutely right , there is a role for all in innovation . I t is just that leadership is a
particularly essential element . M any organizations in healthcare for many years have
been investing in continuous improvement , but there is a physical limit to how far most
continuous improvement or quality improvement programs can go because they are
designed to squeeze innovation into little pieces of slack time in the organization ; it's
everybody’s part - time job. Something really important happens when you commission a
dedicated full time team for a single innovation initiative and that’s the other part that’s a
little bit more subtle but extremely important is that suddenly you have a whole new

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

degree of flexibility and that is you can rethink from scratch what everybody’s job is and
team redesign is at the very core of innovation in healthcare delivery.

Mark Masselli: We are speakin g today with Chris Trimble, author of How Physicians
Can Fix Healthcare. He is a professor in the Master’s in Healthcare Delivery Science
Program at Dartmouth ’s Tuck School of Business. Chris you know we have been very
engaged in these clinical Mic rosyst ems , really something that came out of Dartmouth
but it's all about a partnership within the organization and that’s I think you said is where
the challenge lies . T alk about this larger partnership that you envision.

Chris Trimble: To talk about the powe r of a dedicated team is indeed to oversimplify .
T hat is a critical step to take but these teams never work in isolation and so what you
end up with is what I describe as a partnership between a dedicated team and a shared
staff and while the dedicated te am has at least in theory infinite flexibility, a shared staff
has almost no flexibility. They are already locked in to their existing care models and
care processes and already have extremely busy schedules so treating the shared staff
well is something of an art . Y ou have to make it as easy as possible for the shared staff
to contribute to the innovation , a nd of course you want to share credit with the shared
staff at every opportunity you get and ma ke it feel like the victory is theirs as well as it is
that of a dedicated team.

Margaret Flinter: Well Chris , you have also said that there – in your research in
estimation – might really only be a couple of hundreds systems across the country that
are really ahead of the curve in implementing breakthrough innovation . M aybe tell us
about a few of those systems across the country that you think are really ahead of the
curve in implementing breakthrough innovations and maybe a few words about what
those innovations are that so impress you.

Chris Trimble: Sure. So you are absolutely right in saying that the commissioning of
small full - time teams has not been the norm in healthc are. Probably , the most
important unexpected step that I am pushing for and asking senior leaders in health
systems to make is to commission those teams far more often than they are today. I
think that what you have in healthcare is a knee jerk reaction to doing so that is really
the residue of our fee for service mindset.

Once we get past that what we are going to see is very modest size risks with the high
probability of return and in fact these risks are paltry when compared to other risks that
healthc are leaders are quite accustomed to , like building new buildings or new wings for
the hospital or even merging with a rival across town. I would say there is not a
hundred systems across the country that are doing this well ; I would say there is none .
T h ere are hundred or a couple of hundred examples of projects that have happened

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

one way or another because of a single committed senior leader that wanted to see it
happen or because the project was grant funded in some way, had some other special
source of funding.

One that I talk about frequently is from Salt Lake City and Primary Children’s Hospital in
particular which is run jointly by Intermountain Healthcare and the University of Utah .
Here the population, the patient population of interest is childre n with complex medical
conditions and yet they are overwhelmed and very often it's the case that they are given
conflicting advice from multiple caregivers that are working with them , s o the i nnovation
leader in this case was Dr. Nancy Murphy who started recognizing the ways that the
system fell short for these families as early as her residency , a nd she had the chance to
build a small clinic . I t was a dedicated team , a small full time team of four people and
because it was a dedicated team they had the flexibility to reinvent what they do at work
everyday and what they created was a clinic in which every appointment is quite lengthy
60 minutes, even 90 minutes a nd during which time you might s ee, in fact you are likely
to see all four members of Murphy’s team up to four families might be in the clinic at one
time , at the end of the 60 or 90 minute session they would all huddle and share insights
and recommendation and then go back and have one final discussion with the families.

These families are, they have a lot to think about and they are often dealing with trauma
and so more than a third of the clinic’s time was left free of appointments to enable
ample bandwidth for phone calls, for email, for follow up both with the families and the
others that were involved in the care. The result, well patients and their families are far
more satisfied , and despite the extra that was spent in this clinic , cost s overall to the
system were down by well ove r 10%.

So I would tell you, I share this story a lot and very often the reaction is a bit
understated and there was accurate recognition that there was no intellectual
breakthrough here and what this was, was simply more time for care planning and care
coo rdination a nd that is exactly right in fact that’s the point we can get dramatic double
wins through the proper application of common sense ideas that have been around for a
long time. Anybody that can deliver a dramatic double win is a hero in my book.

M ark Masselli: And some seem to hold promise , wide waterfront of devices out there ,
self tracking , t elemedicine , remote monitoring, but I am wondering if you could talk
about how these emerging tec hnologies may or may not accelerate the pace of care
delivery innovation and what is your research telling you.

Chris Trimble: I think they will help transform healthcare ; I just don’t know how. I don’t
think anybody knows how, how important say a wearab le device or some of the new cell
phones apps are going to be or some of the new telemedicine technologies are going to

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

be and I am not going to judge whether high - tech is more important than the low - tech
stuff that I am writing about. I think there is pr obably value to be gained across the
board . I will repeat my big fear and that is we will get so carried away with our
infatuation with science and technology that we will overlook the opportunities that are
very near to hand.

Margaret Flinter: We have b een speaking today with Chris Trimble innovation expert
and author of How Physicians Can Fix Healthcare – One Innovation at a Time. You can
learn more about his work by going to exec.tuck.dartmouth.edu/news or you can follow
him on Twitter @trimble_chris . Chris , thank you so much for joining us on
Conversations on Healthcare today.

Chris Trimble: It was a pleasure being here, thank you very much.

Mark Masselli: Right.

(Music)

Mark Masselli: At Conversations on Healthcare , we want our audience to be tru ly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org , a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of decepti on in US
politics. Lori what have you got for us this week?

Lori Robertson: Hillary Clinton claim ed that a recent study showed white middle - aged
Americans without a high school education are dying earlier than their parents and their
grandparents. One of the authors of that study told us it “doesn’t” establish any of what
she said . The study found an increased mortality rate among that age group since
1999 , but it made no comparisons with past generation.

The study was written by two Princeton Economist s Angus Deaton a nd Anne Case and
published online November 2 by the Proceedings of the National Acade my of Sciences.
It found that the mortality rates for non - Hispanic whites 45 to 54 years old has increased
by 34 deaths for 100,000 people from 1999 to 2013 reversing a “remarkable” long term
decline in mortality rates in the United States. T hat increase was driven primarily by
those with a high school degree or less . T he mortality rates for that group during that
time increased by 134 deaths per 100,000. One of the authors , Deaton , told us in an
email that the study did not say anything about people wi thout a high school education
as Clinton claim ed .

More important , the study didn ’ t make comparisons with past generations . Clinton
claims that the study shows middle - aged Americans are dying earlier than their parents

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

and grandparents. Deaton says the study doesn’t look at that question at all , and he
told us that he would be surprised if her claim were true especially for gr andparents
given the general decline in mortality prior to 1999 and that’s my fact check for this
week. I am Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major politi cal players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.
(Music)

Mark Masselli: Each week Conversations highlights a bright idea about how to make
w ellness a part of our communities and everyday lives. Falling is a common experience
among the elderly and that is not good news.

Drew Lakatos : Hip fractures in the elderly are enormous devastating expensive , death
sentence of an injury. If you are over 65 and you have fallen and broken your hip , 25%
of them will die within 12 months. Another 25% will never be able to live independently
and a full 75% will never regain full mobility.

Mark Masselli: That statistics got former A irbag executive Drew Lakat os thinking what if
you could apply the technology used in airbags to create wearable devices that protect
a person from the impact of falling.

Drew Lakatos : So our government has spent billions in about two decades on fall
prevention programs for the eld erly . W hat I am suggesting is we make that same
strategic shift that the auto industry did and we begin focusing on intelligent protection
of our elderly.

Mark Masselli: So they did their research and found a combination of accelerometers
and other sensors on the band worn around the waist could deploy within 6 milliseconds
of sensing an imminent fall , significantly reducing the blow to the joint.

Drew Lakatos: With the right technology , we can ensure that these people that meet
that inev itable , immovable object which is the floor can not only survive that accident
they can walk away. With this type of technology , we can protect against concussions ;
we can now protect Coumadin patients. We can protect our military soldiers from IEDs.

Mar k Masselli: A simple retooling of airbag technology leading to better health
outcomes, lower health cost , and better quality of life ; now that’s a bright idea.

(Music)

Chris Trimble, author of How Physicians Can Fix Health Care One Innovation at a Time

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.