A strong robotic-assisted surgery service line can help support hospital and health system efforts to improve surgical care and manage costs, as surgical robots support minimally invasive procedures which are associated with shorter lengths of stay and quicker recovery for patients. But launching and maintaining such a program is not without its challenges. To overcome these challenges, healthcare organizations can learn from peer organizations that have achieved excellence in robotic surgery.
New Hyde Park, N.Y.-based Northwell Health is an example of an organization that has established a top-performing robotic-assisted surgery program and learned from its peers along its robotics journey. In 2018, it became the first health system to receive the network of excellence in robotic surgery designation from the Surgical Review Corporation. Becker's recently spoke to three Northwell leaders about the growth of the health system's robotics program as well as how exchanging ideas with their peers helped drive its success further.
Northwell Health's da Vinci journey so far
The system began to grow its da Vinci offerings by establishing a system robotics committee four years ago. The program has grown quickly since then, experiencing 86 percent growth from 2016 to 2019, Frank Cascio, director of system robotics said. It grew its fleet of da Vinci systems from 12 to 25, and the number of hospitals within the system offering da Vinci services increased from 8 to 12. The health system entered 2019 with more than 6,700 procedures completed across its hospitals.
As Northwell Health implemented a formalized strategy to grow its da Vinci-assisted surgical services, leaders encountered several challenges, ranging from traditional obstacles related to emerging innovation and technology to behavioral characteristics of its workforce, said David Battinelli, MD, senior vice president and CMO of Northwell Health.
The health system used a strategic approach to grow the program that included bringing the executive, operational and clinical arms of the organization together. The system robotics committee, which includes representatives from all Northwell hospitals that have a da Vinci system, identified four pillars to ensure the program's success and allocated resources through four subcommittees: education, quality, credentialing and operations. Northwell leadership decided that they would continue to invest in the da Vinci program if they were successful in the four areas overseen by the subcommittees even before the financial rewards of the program became clear, Dr. Battinelli said.
"We were doing it to be on the cutting edge and to be able to demonstrate enhanced quality," he said. "Emerging technologies sometimes promise that there will be financial rewards. But technology is always expensive, and we just wanted to make sure that the quality [improvement] would be clear enough to compensate as a return on investment for some margin in either direction on finances."
The health system also made sure that the physicians understood that the success of the program depended on strict monitoring of credentialing as well as of the surgical procedures themselves.
"If the physicians themselves could not adequately police their own safety and quality, we would not be successful and we would not continue to invest [in the robotics program]," Dr. Battinelli said.
But the team behind the da Vinci program at Northwell Health was curious as to how teams at other organizations grew their programs, specifically how they brought together the executive, clinical and operational sides of their organization to ensure the success of their da Vinci programs and what kind of data they were collecting.
To gain a better understanding of the strategies implemented by their peers and exchange new ideas for growth, Northwell Health began participating in the Intuitive 360 users conference.
An educational opportunity for the entire da Vinci team
The Intuitive 360 users conference, now in its fifth year, is an annual event where attendees can participate in activities and sessions encompassing all aspects of a da Vinci-assisted surgery program. The conference has grown over the last five years and typically sees 1,500 healthcare leaders come together from around the world. What makes it so impactful is that it includes dedicated tracks for clinical, operational and executive leadership, and this year will offer over 20 virtual sessions to choose from. Northwell Health has sent a team to the conference for the past two years.
"The 360 event is not just for the surgeon," said Gainosuke Sugiyama, MD, Director of Surgery and Chairman of Surgery at Long Island Jewish Valley Stream (N.Y.) hospital at Northwell Health. "It's a meeting for the clinical team, the surgeon, the administration. We went with an open mind as to what is it that we could take away from each section and then bring it back to our organization."
The conference also allows for an open peer-to-peer exchange of ideas during breakout sessions. For example, the Northwell da Vinci surgery team gleaned several insights regarding standardization across the continuum from their peers at the conference, said Mr. Cascio. Other areas of interest were data sharing and analytics, particularly with respect to using artificial intelligence to mine data sets and credentialing pathways.
"The beauty of going to multiple breakout sessions is you can take pieces from each individual session and bring them back into a holistic approach to delivering on our goal which is standardization of quality and care," Mr. Cascio said.
In addition, the Northwell team took away several key insights from the conference that they used when they were developing a new da Vinci program at LIJ Valley Stream hospital. There was even a specific session on applying for the Center of Excellence designation given by the Surgical Review Corporation, Dr. Sugiyama said. He paid close attention to what other hospitals did to ramp up their volume and prepare for the process of becoming accredited. The hospital earned its SRC accreditation as a Center of Excellence in robotic surgery in July 2020.
"We do benefit from the networking and the peer-to-peer discussions, but we also have some safety rails and guards that we can't stray from," Dr. Battinelli said. "That said, when we learn about quality and safety approaches and how to form the networks and what seems to work — that is invaluable. This is not rocket science. The secret sauce is simply better patient outcomes."
Advice for new attendees
Attending the conference has been highly beneficial for Northwell, Mr. Cascio said, adding that new attendees should take time to prepare before the event. The Northwell team suggests taking a divide and conquer approach, mapping out the sessions your team is most interested in and deciding beforehand who will attend which session. Executive, clinical and operational leaders in your health system can attend the sessions designed for their roles, and the team can come together to debrief later.
Northwell's representative from Intuitive also sat down with the robotics team to help them decide which sessions would be most helpful for them.
So, would they recommend the conference to other healthcare organizations with robotics programs? Absolutely yes, said Mr. Cascio.