How to use data to grow and scale a successful da Vinci surgery program: Lessons from Northwell Health

Although many health systems are exploring da Vinci-assisted surgery, the cost and complexity can be intimidating.

The key to creating and growing a successful da Vinci program lies in making data-driven decisions, building a thoughtful training program and right-sizing existing resources.

During a workshop sponsored by Intuitive at Becker's Hospital Review'13th Annual Meeting, Frank Cascio, assistant vice president of program management, and Aaron Macoskey, program director of system da Vinci surgery — both of Northwell Health — shared their organization's journey in rapidly growing a successfully da Vinci program as well as advice for others wishing to do the same.

Four key takeaways were:

1. Having accurate data is essential to establishing and expanding a successful da Vinci-assisted program. According to Mr. Cascio, back in 2016, the executive team was interested in making investments in cutting-edge technologies, but Northwell didn't have much data or intelligence about its da Vinci surgery program. "My role was to help us understand the impact and the benefit of da Vinci surgery for our patients," Mr. Cascio said. 

"We've been able to benchmark our program nationally and against other modalities with the help of Intuitive Surgical," he said. "Over the years, we've been able to demonstrate a superior quality outcome for da Vinci-assisted surgery, which has led to continued investment in our program. We started with 12 robots in 2017, and we will have 83 robots by the end of this year. That's a tremendous amount of growth; we've been able to collect enough robust data to make data-driven growth decisions."

2. Northwell has invested in building excitement for da Vinci-assisted surgery at every level of its staff. While new residents receive some da Vinci training before entering the workforce, Northwell has prioritized building its da Vinci-trained staff. Mr. Macoskey explained that although many residents and surgeons want to transition from traditional open or laparoscopic surgery to a da Vinci approach, it's important to conduct a collaborative evaluation of every surgeon. "It's multifactorial," he said. "Do they have the anticipated volume they need to continue to perform procedures?" Mr. Cascio noted that traditionally 20 procedures are required to normalize the operative times and outcomes. "That's where we can begin to appreciate the efficiency and value add that a true da Vinci surgery program offers," he explained.

It's also important to train ancillary staff to support volume growth as well as help surgeons build their referral basis. "If you can drive excitement around the da Vinci program, everyone will start to feel a part of it and will enjoy what they're doing. Open communication and lots of transparency means that everyone is speaking the same language and is interested in the same goals and vision," Mr. Macoskey said. 

3. As the data and training pieces fall in place, it's important to right-size and improve operations. According to Mr. Cascio, Northwell's projected growth in da Vinci-assisted surgery is about 30 percent per year. "In 2017, we did 737 outpatient procedures. This past year, we closed out around 5,000; low-acuity growth has really taken off." He also explained that "initial applicants are requesting privileges to perform robot-assisted surgery. Now we need to right-size our entire perioperative space."

"OR real estate is not getting any larger," Mr. Macoskey said. "If we know we're decreasing our laparoscopic volume while increasing our da Vinci volume, we need to analyze how to be more efficient and understand where the dollars are being spent in the OR." Northwell has been able to do this successfully through its Intuitive partnership and the MACA data team.

4. For other health systems embarking on building a da Vinci system, focus on the key pillars of success. Mr. Cascio encouraged health systems to develop an acquisition model, partner with Intuitive, establish a governance structure, standardize the program, disseminate the information and lead with data transparency. "Our program success has been defined by these pillars of success," he said.

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