How Hackensack Meridian Health's robotic surgery service line achieved lower costs, increased surgeon satisfaction

The strategic use of robotic surgery service lines has the potential to help hospitals achieve lower costs while also improving clinical outcomes, patient experience and provider satisfaction.

During a March 11 webinar hosted by Becker's Hospital Review and sponsored by Intuitive, industry experts discussed how the implementation of a robotics surgical service line has the potential to support hospitals' pursuit of the Quadruple Aim. Both Michael Stifelman, MD, chairman of urology and director of robotic surgery at N.J.-based Hackensack Meridian Health, and Jim Assenmacher, regional director of market access with Intuitive, shared strategies that can drive a sustainable program and help care teams deliver quality care no matter the time of day.

Partnering with clinical leadership — The 5 traits of a true surgeon champion

With over 16 years of experience in robotic surgery, Dr. Stifelman directs Hackensack Meridian Health's robotics service line, which includes 15 da Vinci robots. With the majority of urology surgeries at Hackensack done robotically, Dr. Stifelman is certain the trend towards more robotic surgeries will continue across many specialties including general surgery, colorectal and thoracic.

To drive programmatic change, leadership must first identify a true ‘executive surgeon leader.’ According to Dr. Stifelman, a true surgeon leader does the following five things: places the program above individual needs; aligns to executive strategy and communicates value; supports the operational team and establishes culture in the operating room; uses data to drive change; and establishes credentialing and block scheduling. Dr. Stifelman recommended health systems create a job description program for surgeons to match.  

After identifying surgeon leaders, health systems should use the Quadruple Aim to drive alignment. Robotic surgical service lines have the potential to support the four tenets of the Quadruple Aim — enhancing patient experience, improving patient outcomes, lowering total cost of care and enhancing provider experience. The use of robotic surgery has the potential to provide improved outcomes, according to Dr. Stifelman. And while robotics may initially increase costs, it can eventually help lower the total cost of care by improving quality of care. 

Surgical robots can also help support better rates of physician satisfaction, Dr. Stifelman continued. "Surgeons like robotics for a variety of reasons," he said, adding that robotic specialists working with surgeons are dedicated and efficient. 

Key initiatives for service line alignment 

To successfully establish a robotics service line, a culture of trust must be established. An important piece of building trust is articulating goals, which gives employees direction and purpose, according to Dr. Stifelman. Another key component is transparency, which can be supported by making data accessible to staff. Other trust building strategies include creating standard operating procedures, identifying easy wins achievable within the first year and celebrating said wins.

After establishing trust, data should be leveraged to realize strategic priorities. When talking to an executive team, important data focuses on growth, positive contribution margins, payer mix driving revenue, operational excellence and decreasing variation in cost management. Data discussed with surgeon leaders should center around how robotics may help clinical outcomes by the potential for reduced complications and readmissions. It's critical to build data dashboards that demonstrate these measures and the value of the robotics program, Dr. Stifelman said.

Most clinical data should be measured by procedure so it's easier to compare surgeons, readmissions, transfusions, mortality rate, clinical and economic value to the hospital. Data should be shared at quarterly task force meetings. 

Vertical integration should be established so strategies can be driven by executive leadership, clinical excellence and operational excellence teams. The top-down alignment begins with executive leadership and filters down to operational oversight and then day-to-day operations staff. The structure gives day-to-day operation staff the ability and resources to talk to someone if they have problems that need addressing. 

Robotic surgery at Hackensack University Medical Center

With robotics, Hackensack (N.J.) University Medical Center, Hackensack Meridian's flagship hospital, experienced a decrease in OR time, improved set-up time, procedure standardization, an increase in complex cases and an increased inpatient volume. 

"As we move to the future, we have a shared vision focused on change management with actionable data," Mr. Assenmacher began. He spoke of the reciprocal relationship between Intuitive and HUMC, one of the first hospitals to implement da Vinci, and how both companies learn from each other. Earlier, Intuitive's relationships with hospitals were more transactional, while now they have evolved into a quality-focused approach.  

Setting clear goals help drive the right action plan. Intuitive's Market Access and Custom Analytics team provides HUMC market insights and best practices. The team can help hospitals understand possible constraints for a number of areas including expanded da Vinci access. If systems don't address these constraints, they can lead to costly variation. 

Intuitive's robust analytics engine includes over 7,000,000 surgical encounters documented across 5,100 deployed da Vinci robotic systems. The analytics engine integrates HIPAA compliant health system program data in efforts to identify clinical, financial and operational variation within an organization. The technology can help hospitals diagnose problems and understand how to remove barriers using three core strategies. One, belief: the philosophy that lack of clinical outcomes data can result in care team misalignment. Secondly, access: based on the idea that an inability to add cases can lead to higher open surgery rates. Finally, coordination: variation across all training leads to inefficiency and high costs. 

Conclusion 

To establish a successful robotics service line, hospital leaders must build their programs around the tenets of the Quadruple Aim and leverage data to establish a culture of continuous improvement and foster surgical care team buy-in. 

You can watch the webinar here.

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