Minimally invasive surgery (MIS) is the primary engine of surgical services programs in hospitals around the world, with robotics being rapidly embraced as the surgical technology enabler to advance MIS.
A question we hear often is, what are the most important things to keep in mind when starting a new robotics program?
We sat down with Josh Feldstein, President and CEO of CAVA Robotics International, a global robotics program consultancy partner, to dig deeper into the top five questions a hospital should answer in order to successfully launch a best practice robotics-assisted surgery (RAS) program.
Before getting started, hospitals should define why they want to adopt robotics in the first place. “If the objective is simply to compete in the market or competitively just check a box,” says Feldstein, “that could prevent the hospital from setting the right goals necessary to achieve success with their new robotics program.”
The reason to start a robotics program should be closely tied to the hospital’s vision for their minimally invasive surgical (MIS) program — with robotics representing a critical component of the overall minimally invasive surgical services. Robotics requires a commitment to excellence in MIS. It also takes an investment of intellectual capital. Rushing into it — without considering how robotics ties to the hospital’s overall vision of quality, patient satisfaction, efficiency, and what it means for the organisation — could lead to cutting corners and not considering the many different elements that lead to program excellence.
–Josh Feldstein, President and CEO, CAVA Robotics International
Once the reason for starting a RAS program is clearly defined, the next step is to create a business and operating plan. “When you talk about a plan,” says Feldstein, “you can think about monetising the value of the investment, of course. But it goes way beyond that. One of the things that's super important is figuring out how your stakeholders will govern this program.”
A well-thought-out robotic program management plan needs to go beyond profitability alone. Certainly, it’s important to think through the financial elements. But it’s also imperative to plan for how the program’s management will work; how the robotic committee will be structured and run; what surgeon credentialing looks like; how data will be captured and analysed for ongoing program maintenance and evolution; how surgeons and OR teams will be trained; and how program success will be measured. A hospital needs to understand and formally define these different components to ensure that the program will be successful.
Creating a business and operating plan must also include training. This applies to the function and troubleshooting of the robot, as well as training surgeons and OR crew in actual practice. Hospital administration must also be trained in robotic program best practices. Hospitals thus need to know where to obtain high quality training to ensure their teams learn and apply programmatic best practices.
“The starting point for training is obviously the vendor,” says Feldstein. Typically, vendors will offer basic training in how to use the robot, including the parts and pieces of the machine and the overall “buttonology.” They’ll create a pathway to ensure that surgeons and OR teams are trained and ready to safely operate the system. But they rarely provide adequate support regarding program governance.
Overall, because global training standards for robotic programs don’t yet fully exist, it can be difficult to locate the most optimal training resources. Finding the right partner to analyse the options and enable effective training is thus a critical component of success. For hospitals just entering the robotic services market, seeking a robust training program that also provides opportunities for pre-clinical procedural simulation and experience, along with access to faculty and proctors to support adoption, will further ensure program success.
Data is an integral part of an efficient and well-run robotics program. “Hospitals that do not have a commitment to excellent data capture and strong performance analytics should not get into robotic surgery,” says Feldstein, “because their program will not be fully successful.”
While hospitals have always collected data, many still struggle to understand how to use data to build deep insights into their operations. These insights should be able to answer critical questions like, “is robotic surgery better than traditional laparoscopy? How do we measure the degree to which this technology is better or worse? Is this program making money or losing money? Are robotics surgeries improving patient outcomes?”
Hospitals will find success is much more attainable when they obtain the necessary data, generate detailed and accurate analyses of these data, and know what to do with it — in order to drive a wide range of programmatic quality improvements. Here are a few key steps you can take to get started:
When it comes to starting a robotics program, look at the surgeons, staff, and administration who will be involved. Will they show up ready to learn? Are they invested in the success of the program? Do they know their role in the future of the program?
“Robotics is a team sport,” says Feldstein. “A key factor in the team’s success relates to each person having what is called a ‘growth mindset’.” That means every single team member must be willing and eager to learn and continuously improve. They need to be ready to jump in, willing to work beyond insecurities and early fears, seeing challenges as the springboard for both personal growth and program success. And they must express a desire to put highest quality patient outcomes and professional skill development first.
Success depends on creating a robotic program “culture of performance transparency” and stakeholder accountability. “In a growth mindset culture,” explains Feldstein, “learners are motivated by their desire to get better. They aren’t worried about making mistakes, but rather are excited about improving their knowledge and their capabilities.” Plus, when each team member is held accountable for their individual performances, the team as a unit is inspired to be the best it can be.
No hospital sets out just to buy a robot. Rather, it sets out to build an effective robotic program, one that attracts new patients and superior robotic surgeons, enabling greater access to minimally invasive surgical care. By answering these five important questions, hospitals can be confident they will be able to build a robotic-assisted surgery program designed for success.
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).