Several years ago, while working as a Medical Director of Surgical Services for a large healthcare system in the southwest, I had the opportunity to review a substantial amount of data and information regarding our robotics assisted surgery programs. Because of that review, combined with what I have learned since then, I’ve concluded that highly-structured programs perform much better compared to poorly-structured programs.
This is the first in a nine-part series describing exactly what a highly-structured program is and how to develop one. Before we go into the details, let’s look at the data supporting this statement regarding program structure.
There was significant variation in outcomes across our system and we wanted to understand what was driving this variation. One of the more obvious drivers was surgeon volume. When we compared the high-volume surgeons (top 20th percentile) to the low-volume surgeons we found marked differences in complications and costs. The risk of complications was 36% greater for low-volume surgeons compared to high-volume surgeons. Costs were 20% higher for low-volume surgeons compared to high-volume surgeons. This wasn’t the only driver of outcomes.
We could see variation in the facilities as well. Through a series of surveys and site visits, we determined that each facility’s robotics program was structured differently. Highly-structured programs performed better. The complication rate of a poorly-structured program was 46% greater than a program that was highly-structured. A similar observation was made with cost. The cost in a poorly-structured program was 37% higher compared to a highly-structured program. Since this analysis, I’ve spoken with hundreds of people involved in robotics programs across the country. This is not an isolated observation; more and more programs are realizing the benefits of organizing their program for superior performance.
This series will describe one way to organize your program. It is based on a simple model known by the mnemonic SPECIAL PI. This stands for Seven Pillars, Purpose, Engagement, Communication, Infrastructure, Accountability, Leadership and Performance Improvement. Each segment of this series will describe these pillars in more detail. To learn more, go to https://loftushealth.com/and download a free PDF copy of The Robotics Program: A How-to-Guide for Physician Leaders on Starting Up a Successful Program.