5 keys to success when deploying a robotic surgery program


In the more than two decades since da Vinci robotic-assisted surgery began to shift from a theoretical premise to a plausible option for minimally invasive surgery, hospitals and health systems have reaped the potential rewards that may include fewer complications and shortened recovery time following even some of the more complex operations.

Orlando Health, for example, conducted its first da Vinci robotic-assisted procedure, a prostatectomy, in 2005. The health system has since seen its number of robotic surgeries tally above 4,000 per year. In that time, according to Orlando Regional Medical Center COO Carlos Carrasco and Chief Surgical Services Officer Sherry Buxton, RN, Orlando Health's surgical robotics program has helped the health system better align with the tenets of the quadruple aim.

The most crucial aspect of the program, Mr. Carrasco said, has been its ability to improve patient outcomes, resulting in reduced lengths of stay and readmissions, as well as greater consistency in care delivery. Beyond that, the robotics program has also contributed to reductions in the cost of care at Orlando Health and improved the experiences of both patients and providers.

During a July 18 webinar hosted by Becker's Hospital Review, Mr. Carrasco and Ms. Buxton discussed the steps the health system has taken to ensure the success of its robotic surgery program.

Here, according to Mr. Carrasco and Ms. Buxton, are five keys to that success.

1. Shift to a strategic mindset: Rather than simply reacting to changes in the volume of surgeons using da Vinci robotics at Orlando Health, the health system has learned to take a more proactive approach.

"We make this part of our annual strategy for surgical growth: We look at which surgeons are coming into the market; of our employed surgeons, which ones have been robotically trained; what are our current volumes; and what are we projecting for next year," Ms. Buxton said. "Then we try to assess what we're going to need for our future growth. It's part of our capital investment plan, our staffing plan and our recruitment for surgeons."

2. Get leadership on board: For the first decade Orlando Health utilized da Vinci robotic-assisted surgery, many of its executives saw the technology as a singular tool, rather than the centerpiece of an entire program. It wasn't until the health system's president spoke to surgeons about the quality benefits of robotic surgery compared to open and laparoscopic surgeries that the importance of expanding the robotics program became clear.

"He quickly figured out that more robots can mean more surgeries, and more surgeries equals higher contribution margins," Ms. Buxton said. "It just flows very smoothly into growing a robotic program and growing surgical growth."

Even Mr. Carrasco admitted he was initially something of a "naysayer" regarding surgical robotics. This lack of executive buy-in is especially common among system presidents and CFOs, who need to understand the reasoning behind spending millions of dollars.

3. Enlist surgeons to champion the cause: Just as important as getting executives on board is tapping expert surgeons to evangelize about the abilities of surgical robotics to the rest of the clinical staff. Not only will these surgeons be able to influence the rest of the staff to buy in to the program, but they can also work with residents and train other surgeons to use the robots, making surgeon champions an absolutely essential part of the core robotics team, per Ms. Buxton.

4. Smooth out OR operations: Efficiency is key when implementing any new program, and robotic surgery is no exception. "You can't have hour turnovers between robotic cases; no surgeon's going to be happy with that," Ms. Buxton said. Ultimately, it will come down to the team members in charge of spearheading the program, each of whom should be tasked from the beginning with prioritizing efficiency and chosen with that in mind.

5. Create consistency in the program: As it advanced and expanded, Orlando Health made sure to standardize the structure and metrics across the entire program. First and foremost, they established a robotic steering committee comprised of physicians from each service line, as well as members of the operations, marketing and quality teams.

Pursuing the Surgical Review Corporation's Center of Excellence in Robotic Surgery accreditation also helped the system maintain high levels of quality improvement in the program. And finally, Orlando Health standardized both credentialing and quality metrics, enabling consistent analysis across all service lines.

To learn more about deploying a surgical robotics program, view the webinar here.

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