With the right strategy, alignment and technology, operating rooms can become sites for innovation and critical improvements in efficiency and patient outcomes.
Tacoma, Wash.-based MultiCare Health System is one such example of an organization that, five years ago, successfully deployed a multidisciplinary, minimally invasive robotics program for colorectal surgeries that continues to generate capacity, growth and patient satisfaction with streamlined procedures.
To learn more about the health system's strides in surgical innovation and key outcomes, Becker's Healthcare spoke with three program stakeholders at MultiCare:
- Chris Hunt, BSN, RN, AVP of perioperative services
- Laila Rashidi, MD, colorectal surgeon
- Eddie Bratko, president, MultiCare Tacoma General and Allenmore Hospitals
Editor's note: Responses have been edited lightly for length and clarity.
Question: Tell us about where you're seeing growth in MultiCare Health System's surgical services — how are you innovating within the organization?
Laila Rashidi, MD: MultiCare has advanced the multidisciplinary approach to minimally invasive surgery (MIS). This approach helps drive referrals for acute complex cases that require more than one surgeon's specialty. This has been developed extensively over the past five years.
Chris Hunt, BSN, RN: We are seeing double-digit growth across our region for total surgical cases and over 25% growth of da Vinci robotic cases.
This is in part due to:
- Adopting a "24/7" mindset for da Vinci cases
- Training all our surgical staff members so patients can receive the same level of care, regardless of day or time
- Becoming one of the first outpatient surgery centers in Washington state to offer the da Vinci platform for MIS
- Providing better teaching experiences for hosted surgeon residents and fellows with a dual console da Vinci Xi, and integrating several Intuitive platforms — da Vinci Xi, Single Port (SP), Ion and da Vinci 5 (dV5) — under one program
- Conducting cutting-edge research on advanced Enhanced Recovery After Surgery (ERAS) protocols and emerging technology (dV5 and SP). With 10 publications, MultiCare Health System is one of the most published institutions in the country and the only one published in Washington state.
- Ensuring robot access through strategic placement agreements
Q: How did you gain alignment in your health system between surgeons, care teams and executives to build your multidisciplinary program?
CH: We started by rebooting our overall OR governance structure to be multispecialty, physician-led and administration supported. We then laid the foundation for our robotics committee by pulling together resources that describe world-class robotics programs; conducted study trips to learn from other top programs; collected and analyzed data related to efficiency and outcomes; and empowered our teams to make meaningful change.
Eddie Bratko: I am new to MultiCare and Tacoma General and Allenmore Hospitals, as I took on this role about six months ago. Shortly after I started the job, Dr. Rashidi approached me about the possibility of gaining early access to the newest da Vinci 5 system. We talked about it and agreed it was an interesting enough opportunity that we should explore it. I think it is important for executives to listen to their providers when they are looking at new technology and to engage them in figuring out the best way to justify it if an investment is needed. Dr. Rashidi was more than willing to understand the challenges presented in acquiring new technology at a time when most hospitals are financially challenged.
As a good partner, I also listened to her and our other da Vinci trained providers to really understand how the new technology could help them take better care of our patients.
Q: What is the strategic importance of your hospital having a robust colorectal surgery program, and how has that been reflected in your hospital's prioritization and investment strategy?
CH: In the U.S., colorectal cancer is the third-leading cause of cancer-related deaths in men and the fourth leading cause in women. When combined, it becomes the second-most common cause of cancer deaths.
MultiCare's colorectal care team is leading the way through clinical innovation and application of ERAS protocols that are producing excellent outcomes — less pain, fewer complications and faster recoveries — in addition to saving numerous lives. Because of these great results and teamwork, it made it very easy not only to prioritize and fund this work, but also point to this program as a model for other service lines to follow.
EB: Dr. Rashidi and I quickly found that we share a similar view on how to leverage this technology to take better care of our patients, even though we both looked at the situation from different perspectives. The hospital system I came from most recently had a robust da Vinci program and took a system approach to growing our business. I have always found da Vinci technology to be physician satisfiers and a great way to improve patient outcomes for the right types of surgeries.
LR: From a leadership standpoint, they listened. Having support from the leadership team was very important. They heard our request for high-quality care for our patients and understood that when we have access to this technology, we can be innovative in our approach to treatment.
This support and subsequent innovation enabled same-day discharge for colectomies, enhanced recovery pathway and single-port robotic TAMIS for large rectal and distal sigmoid lesions, while overall offering a less traumatic surgery for patients and much better outcomes. We ultimately experienced increased referrals and market share as a result.
Q: How are you educating patients inside and outside of your community on the benefits of da Vinci surgery?
CH: At the time of decision for surgery, we're educating patients face-to-face on our outcomes. Additionally, Dr. Rashidi speaks at national and international physician conferences on our best practices and was recently spotlighted in an interview with local station KIRO 7 News Seattle for National Colorectal Cancer Awareness Month.
LR: Showing patients what the robot is and how it works is helpful. We have an app called Seamless that shows them what it looks like — we pull up the computer during their appointment and show them. Additionally, we discuss outcomes with the patient like how long they will stay, what the data shows and so on. It's important to be honest with them and show the data, pictures and outcomes. Our advanced practice providers do a lot of the education for patients; they do a wonderful job explaining what the surgery is like and what patients can expect.
EB: This team has done a wonderful job of building a world-class program in a very short period of time. While MIS is performed in the OR, it is important that patients understand everything about it in the pre-procedure setting so they can make an informed decision for themselves. This program does a great job of communicating and educating our patients through the whole continuum of care.
I am very excited to be one of the newest members of the team and helping to continue building on what has been developed over the past five years.
Q: What would you say to others who are considering growing their da Vinci program?
CH: You must start with the right people: a great surgeon-leader, a high-functioning multidisciplinary team and excellent executive support.
Next, establish a partnership with your team from Intuitive, who can help provide best practices and additional perspective on your program's current state and a path to become a world-class program.
Finally, start collecting and learning from the ever-growing amounts of data in your current program to help guide your decision-making.
LR: In summary, I'd challenge other leaders to think about: What do you want for yourself or your family member? I think we would want the least invasive approach possible. Da Vinci is a tool that we have today to give one of the least traumatic and least invasive experiences for the patient.