When a hospital is planning to start a robotics program, inevitably there will be some nuanced challenges and potential barriers. However, for Dr. John Lenihan, Chief Clinical Officer, Surgical Science Mimic Technologies in Seattle, WA, some issues remain common in virtually every hospital setting.
We spoke with Dr. Lenihan to learn about his experiences. “There are three big hurdles to consider when starting a robotics program,” he says. And he would know. As one of the first GYN surgeons in the state of Washington to perform robotic surgery, Dr. Lenihan spent more than 20 years managing the robotics program at MultiCare Health in Tacoma, WA, before moving to Mimic Technologies.
So what are the 3 potential barriers to building a RAS program — and how can a hospital overcome them?
When starting a RAS program, the first big hurdle to clear is getting support from executive leadership. Hospital administration must be bought-in, as they are responsible for prioritising funding across the institution. Expect to encounter some resistance: robotic systems are expensive, and it takes time to train everyone. And you’re likely going up against other departments and specialty areas that are vying for the same attention from executives. How can you achieve buy-in when you’re competing with so many other groups for financial support?
“You have to have forward-thinking, visionary leadership,” says Dr. Lenihan. When the competition is tough and the money is tight, the best way to gain buy-in is to lead with a solid vision and a well-thought-out plan that aligns to the hospital’s priorities. Be able to show how this initiative will deliver patient care and a patient experience that is connected to the hospital’s goals and objectives.
“It’s also critical to demonstrate the financial and outcomes-based benefits of taking a patient-first approach to the program”, Dr. Lenihan adds. Include a training plan, so there is a clear path for the different specialties and groups who will be using the robot. And suggest forming a committee to oversee and regulate the use of the robot to ensure every step is done right. By leading the charge with a strong vision for the future, you’ll help administrators connect your RAS program aspirations with their overall institutional priorities.
–Dr. John Lenihan, Chief Clinical Officer, Surgical Science Mimic Technologies
Effective RAS programs enhance utilisation and drive efficiency. They can also enable more minimally invasive surgeries. However, new RAS programs come with new techniques, new processes, and new ways of doing things. In some hospitals, it might be difficult to make a compelling case for change.
Furthermore, sometimes hospital culture can be fraught with silos. Each silo has its own goals, which can lead to a culture of competition that’s not necessarily healthy. “People can end up working against each other,” says Dr. Lenihan, “because they're each trying to make their own team look better than the other departments.” This culture of competition can lead to a reluctance to share information and collaborate in new ways. How can you drive change in this type of environment, when it seems like the cards are stacked against you?
“The hospital world runs by committee," says Dr. Lenihan. "So, you have to get everyone on board.” These committees are typically categorised by specialty, procedure, and administrative function. To bring a robotics program into a hospital system, you need a dedicated RAS committee. And to be successful, that committee should be widespread and goal oriented.
“For it to work,” says Lenihan, “you just can't decree from above. You must generate support from below. You have to get all the stakeholders involved, from multiple different disciplines.” That means including everyone: physicians, anesthesia, nursing services, engineering, supply teams, financial and marketing – even specialties that won’t be using the robot yet. Each of these areas need to be trained in the use of the robot, to learn how to communicate and be on the same page.
Together, this multi-disciplinary committee will set goals and tackle everything from scheduling and timing in the OR and defining which nurses and teams can work on the robot; to setting up credentialing and privileging for the different specialties and determining who will proctor it. By bringing everyone together, you’ll ease all teams into the culture shift – and you’ll have the stakeholders on board to advocate for the program and generate excitement.
“The whole transparency issue is a big problem in medicine,” says Dr. Lenihan, “particularly when it comes to surgeons and their proficiency.” Measuring and tracking performance can be difficult to implement, especially when new technologies are being added to the OR. No one wants to be assessed while they are improving their skills. So how do you bring more transparency to the factors that really matter?
For Dr. Lenihan, the answer is simple: “You have to be willing to put the patient's interests first – ahead of professional pride. Whatever's going to work best for the best patient outcome, that's clearly the high road, and it’s just the right thing to do.”
Putting the patient first applies to all aspects of the patient experience – including what goes on behind the scenes. Be honest and clear about the skills and proficiencies of the surgical team. Stay transparent with how things are working, documenting usage, utilisation, times in the OR and even complications. Report on everything from efficiency to safety and make the results visible across the system. Put updates in the hospital newsletter and in newspapers and online – let people know what you are doing and how it’s working. By putting patients first and focusing on true transparency, you’ll become the “go-to” hospital for patients in your area.
When it comes to robotic-assisted surgery, technology is evolving so quickly that it requires healthcare organisations to stay focused on what matters most. For us, that means supporting hospitals and surgeons with a holistic approach, focused on the entire RAS program ecosystem. By developing a strong vision for the future, approaching each step with inclusivity and respect, and putting patients first, we can help expand what’s possible in robotic-assisted surgery.
Refer to the Instructions for Use for detailed information regarding the instructions for use, indications, contraindications, warnings, precautions and potential adverse events. In Australia and New Zealand, Hugo™ Robotic Assisted Surgery System is currently indicated for certain urologic surgical procedures, gynaecologic laparoscopic surgical procedures, and general laparoscopic surgical procedures. (Please refer to Hugo User Guide for a full list of specified procedures).