Implementing technological innovations like robotic surgery can make a measurable difference in advancing health equity — something Cook County Health realized at its full-scale tertiary academic medical center and safety-net hospital in Chicago, the John H. Stroger, Jr. Hospital of Cook County.
Becker's Healthcare recently sat down with Cook County Health leaders Erik Mikaitis, MD, CEO, Alex Sauper, MD, general surgeon and medical director of robotics, and Craig Williams, chief administrative officer, to discuss the importance of technological innovation for one of the nation's busiest level 1 trauma centers.
Editor's note: Responses have been lightly edited for clarity and length.
Question: Why is Cook County Health focused on health equity?
Craig Williams: Going back to the origins of Cook County Hospital, the mission has always been to make sure that all residents of Cook County receive the care they need and to be a safety-net hospital. This includes ensuring that people who might not otherwise be able to receive care can access high-quality healthcare as a basic human right.
Dr. Alex Sauper: Part of health equity means having access to technical advancements that improve the care for patients; our patients deserve the highest possible level of care.
Q: Why has Cook Country Health embraced minimally invasive surgery and the da Vinci robotic surgery program?
AS: From a clinical perspective, minimally invasive surgery (MIS) uses small incisions which cause less pain for the patient than larger incisions. This results in a quicker return to activity, which allows patients to get back to work and life sooner. There's also less risk of blood loss, wound complications and morbidity. Plus, patients' length of stay in the hospital post-procedure is shorter but most patients go home on the same day as surgery.
We embraced the Intuitive Surgical da Vinci robotic surgical system because the technology offers expanded capabilities to perform minimally invasive surgery for patient beyond traditional laparoscopy capabilities to achieve even better outcomes. Secondly, there is an ecosystem within Intuitive that further supports institutions that use their technology. They offer surgeon peer-led training courses to expand skillsets and train surgeons, perioperative staff training for nurses and scrub techs, companion mobile app-based case insights to improve surgeon efficiency, and finally data analysis which allows institutions to compare and benchmark their open, laparoscopic, and robotic assisted surgical outcomes both internally and externally to show the value of the robotic assisted surgery.
CW: From a hospital operations perspective, by using the robots, we're going from a length of stay of seven or eight days down to one or two days. That allows us to reduce costs and get the next patient in to receive care.
Another important deciding factor was our aim to train the next generation of surgeons. Until we obtained this technology, we weren't training our surgeons on the latest and greatest tools and techniques. So, one key component was making sure we could support our residency program and were providing equitable access to care and technology.
From an equity perspective, surgical robotics is probably the fastest-growing segment in surgery, and our patients didn't have access to this type of technology.
Financially, obtaining a robot is a big investment. We worked with Intuitive Surgical because they provide innovative financing vehicles, which allow acquiring the robot and paying for it as we're using it. This approach spreads out the initial cost and gets us a return on investment on day one.
Dr. Erik Mikaitis: Establishing a robotic-assisted surgery program represents an investment in our system, and more importantly, an investment in the communities we serve. We know that some procedures simply have better outcomes and are easier on patients when they are done robotically. At Cook County Health, we believe everyone should have access to these kinds of advanced surgical interventions, no matter their insurance status or ability to pay.
Q: In what areas is Cook County Health using the da Vinci robotic surgery program, and what results have you seen?
AS: We are using the da Vinci for general surgery, colon rectal surgery, urology, thoracic surgery, gynecology, otolaryngology, and pediatric surgery.
Anecdotally, patients are doing very well with all of the benefits I mentioned earlier being realized, and we are awaiting our data analysis results to support it.
Q: What advice or lessons would you share with other hospital leaders who are considering a surgical robotics program as part of a health equity initiative?
CW: The primary question leaders should ask is if they are OK missing out on the robotic surgery business. Are your patients receiving the most equitable care? If you don't have a robot, are you gaining the most efficiency in your surgical program? I do think the business case is relatively easy to make. It was a good investment for us. It has a return better than most things we spend money on in the health system.
Also, for folks who are thinking about launching a program like this: I think it's important to have an executive champion, a leader within the surgery team and also a leader in nursing who will work through on-the-ground challenges. It's important to have that leadership because it's about people; it's not about technology.