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There’s no shortage of ad campaigns out there encouraging us to “think big”— or, in the case of Apple, to “think different”. But these expectations are wildly unrealistic, and can lead to unwanted drawbacks. This is especially true in health care.

Earlier this week, Dartmouth’s Chris Trimble explained why this is the case. In a piece for the Harvard Business Review, Trimble argued that the best way for health care systems to improve is not in leaps and bounds, but in measured increments brought on by “small, dedicated teams”.

Trimble turns to history to make his point. Back in 1998, Essentia Health charged a small, dedicated team with the task of improving how health care was delivered to recently discharged patients who were battling congestive heart failure. CHF patients often lack ongoing care or education to keep their condition in check, and all too often wind up right back in the hospital. In Essentia’s case, their small team met with patients, fostered a relationship, and dispensed valuable medical advice to keep them healthy. Over time, this full-time team grew in size and has experienced major success. In the nearly two decades since it was formed, discharged patients have been able to lead healthier lives, which leads to fewer trips for them back to the hospital. But even though the Essentia CHF team had clear benefits for both patients and hospital staff, few in the healthcare community treated the initiative with the praise it deserved.


Because fee-for-service reimbursement reigns supreme, and under that paradigm, innovations like Essentia’s— characterized by small, full-time teams— lose money. And even though these innovations could be incredibly helpful to the industry, few companies are willing to tap into their potential. The ultimate reason, writes Trimble, is that we seem to be stuck in an all-or-nothing approach to innovation.

He goes on to share a cool graph that illustrates the nature of changes. On one end are small changes in productivity and the minutiae of labor. He calls them “frontline process improvements”. Typically, they are small projects that only involve staff on a part-time basis. On the other hand are projects that “think big”— they disrupt, change the way the entire industry does business, or run with a radical new idea. But Trimble asserts that even though such ideas are the desire of all, the pursuit of them is detrimental to the organization for two reasons: they involve full time staff and often call for immense capital and resources— resources some institutions rarely have.

Trimble’s “Idea Map”

Instead, Trimble says that we should be focused on the opportunities for innovation that rank in the middle of that spectrum. A perfect example is the Essentia case that he opened with. At the end of the day, any organization is going to want results. And while dreaming of new infrastructure or equipment is a wonderful thing, the chances of it happening every time is slim. Conversely, those small changes that make existing practices better are a more realistic option. It has the benefit of lower cost and a greater chance of actually delivering results.

Next time your organization starts to “think big”, reel it in and pass the torch to a dedicated team that is committed to making what you already have that much better. Sometimes the biggest innovations begin with the smallest changes.