Quality of care and efficiency of delivery are two areas that set NYU Langone Health apart. The organization has developed tools, processes and systems that have improved results for patients and providers.
During a June webinar sponsored by Intuitive, two leaders from NYU Langone Health shared insights on foundational pillars the New York City-based health system has established to improve the efficiency and quality of robotic surgery procedures:
- Robert Cerfolio, MD, executive vice president and vice dean, chief of hospital operations
- Kathy Huang, MD, director of robotics
Five insights:
- Efficiency Quality Index is the basis of a competitive yet collaborative system that encourages constantly improving performance. NYU Langone Health developed EQI as a measure of the quality and efficiency of every aspect of the health system. "Each member of the workforce receives [EQI] data," Dr. Cerfolio said. Quality metrics are developed by practitioners in each area. For example, surgeons who perform appendectomies define these quality metrics. "The goal [of EQI] is to give patients better care and engage employees to create a transparent, honest culture where each one listens to and learns from someone else," Dr. Cerfolio said. EQI creates engagement and a culture of improvement.
- Process improvements have fueled rapid, efficient growth of robotic surgery. NYU Langone Health's robotic surgery volume has grown by 15 percent to 20 percent per year. To boost efficiency, the health system moved its robotic units to the same floor and implemented a two-week block time for scheduling. This increased efficiency from 400 cases per system per year to 500. "The change in release time has helped maximize utilization through better planning," Dr. Huang said. "It's one of the reasons we were able to increase our surgical volume without purchasing additional systems."
- Dashboards provide comparisons between one surgeon's performance against colleagues and the nation. As a data-driven system, each surgeon receives a quarterly report card comparing their performance to their colleagues. Benchmarks include cost per case, teaching score and patient satisfaction scores. "We also want to know how we compare with the nation," Huang said. "We discovered that in malignant hysterectomies, our operating time was much longer than the national average. When we focused on that area, we were able to bring down the time by almost 30 minutes."
- Standardization is key to driving down costs. An effective cost-containment effort was standardizing best practices of efficient surgeons. According to Dr. Huang, NYU Langone Health found an opportunity in streamlining robotic instrument trays. "We made sure that usable trays only had the instruments the surgeon needed," she said. "Even reusable instruments cost staff time to count them multiple times. We were able to essentially eliminate 80 percent of the instruments."
- Growth of robotic surgery has been fueled by the organizational structure and culture. Robotic surgery at NYU Langone Health takes a multi-disciplinary approach and is led by a comprehensive robotic oversight committee. This committee, made up of representatives from reimbursement, supply chain, perioperative services and central sterilization, allows for open dialogue on alignment of goals through regular monthly and quarterly meetings. This approach, alongside the robotic PAs, which Dr. Huang termed as "the backbone" of the robotic surgery program, in combination with strong executive support for robotic surgery, provide a foundation for continued growth.
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