Since 2005, Sutter Health, a nonprofit, integrated delivery system headquartered in Sacramento, Calif., has been on a journey to become a world-class provider of robotic surgery.
During an August webinar hosted by Becker's Hospital Review and sponsored by Intuitive, two leaders from Sutter Health, discussed the evolution of their robotic surgery program and shared best practices:
- Rick Harrell, Assistant Administrator of Surgery, Cardiovascular Services and Adult Service Lines
- Michael Beneke, MD, Medical Director of Robotic Surgery
Five key takeaways were:
1.) Clarity of purpose is the key to organizational alignment. Outstanding robotic surgery programs start with a clear mission and vision. "Always begin with the 'why' and communicate that," Dr. Beneke said. "As we formalized our multi-specialty robotics program in 2015, our vision was to create a patient-centric experience based on evidence-based medicine, efficiency metrics and data to drive down costs and improve outcomes."
2.) Executive leaders must see the big picture and bring people together. Aligning people is a transformative leadership process that requires multi-directional communication, deep listening and lots of dialogue. Leaders also must be willing to serve as a catalyst for change. "In many instances, an executive surgeon's primary role is to change the culture," Dr. Beneke said. To support change management around the robotic surgery program, Sutter Medical Center, Sacramento pursued a variety of activities. "Change is difficult," Mr. Harrell said. "We developed dashboards, created a peer review committee to look at clinical cases and achieved our Center of Excellence designation in 2018."
3.) Strategic partnerships are often required to achieve program goals. Sutter Medical Center, Sacramento partnered with Intuitive in developing a creative acquisition model to develop its world-class robotic surgery program. "This allowed us to start our robotic surgery program without the patient demand we would have normally needed before acquiring capital." Mr. Harrell said.
4.) Data is crucial for program buy-in and consensus building. To create transparency and to build credibility, Sutter Medical Center, Sacramento created a data dashboard for its robotic surgery program. The team looked at ways to marry its financial and clinical data. "We believe that minimally invasive surgery improves the hospital economics for each of our facilities. To support that, we needed a dashboard to create transparency and to give the robotic surgery program credibility," Mr. Harrell explained. "Having a dashboard is critical — populate it with information that's relevant to your institution," Dr. Beneke said. "Show it at every meeting and monitor the trends you find valuable, such as on-time starts, turnaround times or block utilization."
5.) Developing proactive initiatives can maximize program efficiency. Sutter Medical Center, Sacramento created a robotic downtime prioritization guideline and a point system that determines which surgeons get priority access to a robot. In addition, the organization has developed a robotic surgery advanced surgical scrub role. Individuals in this role can serve as the sole bedside assistant for simpler robotics cases.
6.) The HOPD environment is attractive to patients and surgeons alike. Sutter Medical Center, Sacramento has a hospital-based outpatient department (HOPD) with all the equipment and services needed for robotic surgery procedures. This care setting has X-ray, laboratory and diagnostic services on-site. "Our main hospital is challenging for anyone to navigate. The HOPD is easy to access — patients can pull right up to the building. It's a very inviting environment," Mr. Harrell said. In addition, the HOPD strategy is appealing to surgeons. "From a surgeon's perspective, what's critically important are the efficiency metrics," Dr. Beneke said. "The turnaround time in the HODP is half what it is in the main OR. As a surgeon, that's absolutely where I want to be."
Sutter Medical Center, Sacramento's efforts have paid off. Between 2015 and 2019, robotic surgery case volumes increased from around 700 cases to 1,400. At the same time, direct costs decreased, contribution margins reached 42 percent and profit margins grew from -4 percent to over 20 percent. In 2019, the organization achieved Center of Excellence Designation for Robotic Surgery and that status was renewed this year.
Reflecting on the past few years, Dr. Beneke noted, "From an executive perspective, you need to understand that the total cost of healthcare is more than capital costs or overtime pay. It's many other things that may be below people's radars, like length of stay, readmission rates, surgical site infections and more. As you build out your program, focus on the information that's germane to your organization and your patients."
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