Having performed more than 30,000 robotic procedures during the past five years, Hackensack (N.J.) Meridian Health has one of the busiest robotic surgery programs in the nation and is a leader in the field. Many factors have contributed to this area of the health system’s culture of excellence. The thoughtful, strategic way in which it has been structured is one of the most significant aspects. A vertical alignment structure—which includes involvement from all key stakeholders across the surgical program—has contributed to the program’s success in all four areas of the Quadruple Aim: reducing costs, improving population health and patient experience, and healthcare team well-being.
Vertical Alignment in Action
The overarching purpose of a vertical alignment structure is to create leadership continuity and alignment. “It starts with a collaborative dyad between executive leadership and the lead robotic surgeons, which starts with establishing goals and responsibilities and creating a road map for surgical excellence,” says Mark Sparta, FACHE, president/CEO, Hackensack (N.J.) Meridian Health and University Medical Center.
Next, information derived from the program’s leadership team cascades down to the group that provides operational oversight, which includes surgeons, anesthesiologists and OR team leads, head nurses, robotics coordinators, schedulers, and service line directors. This group is charged with program performance, including measuring goals and developing strategies for achieving them.
Information from that working group is then passed down to the staff members who work on the robotic units, including the attending physicians, OR nurses and med techs. The program allows for transparency and open communication, with all staff members having access to the same data—and working toward the same goals. The structure encourages flow of information—downstream and upstream. “Leaders can only be better at what they do when they have information that’s coming upstream, and folks on the front lines are always better at what they do when we’re fully transparent and everybody is on the same page,” Sparta says.
Vertical alignment has allowed all team members to feel more empowered. “It gives the people who are working here day to day a voice and a pathway for them to enact and create change,” says Michael Stifelman, MD, chairman, Urology, and director, Robotic Surgery. The collaborative culture has been a factor in the health system’s growth, including its ability to provide robotic service 24/7. Hackensack Meridian Health conducts scheduled and acute procedures across 11 specialties in eight of its 17 facilities. Hackensack University Medical Center now has six robots, including one da Vinci single port robotic system. In 2018, it became one of the first healthcare organizations in the nation to acquire the innovative system, which allows surgeons to perform complex procedures through a one-inch incision.
The health system now has a large pool of clinicians who are trained on the robots. Additionally, all nurses are trained in robotics to ensure all appropriate patients are offered minimally invasive surgery. This has been a benefit during the pandemic, as the organization has not been immune to the industry’s workforce shortages.
“In the beginning, there’s this big piece of equipment in the room, and it can seem complicated,” says Terri Freguletti, RN, CNOR, vice president, Perioperative Services, Hackensack University Medical Center. “As the physicians started to share stories about success with the robot, the nurses engaged even further.” The team spirit manifests itself outside the OR just as much as inside it. Nurses look forward to training sessions, particularly an annual course co-taught by a Hackensack OR nurse and an Intuitive representative. Surgeons mentor other surgeons who want to learn robotic surgery. All these and other team-building efforts help grow and sustain the positive culture throughout
the program.
Achieving the Quadruple Aim
The robotic surgery program’s vertical alignment has helped the health system address all four areas of the Quadruple Aim.
“The vertical alignment allows us to make actionable the idea of the Quadruple Aim,” Stifelman says. “It helps us gather the information about areas in which we’re trying to improve, and it gives us a way to measure it. Then, by working together as a group, we’re able to determine what the right things we want to measure are. Finally, it allows us to put our actions into place because leadership has direct communication with our teams who are working on the front lines day to day.” Being able to offer 24/7 access to robotic surgery helps contribute to improved community health. Patient experience and outcomes are improved thanks to benefits such as shorter hospital stays, less pain after surgery, smaller scars and faster recovery times.
Several factors contribute to clinician well-being. Besides the ergonometric advantages of robotic surgery, there’s the satisfaction that comes from being able to deliver what today’s patients desire. “Patients want robotic surgery, and when they come to our surgeons’ offices, the surgeons are able to offer what the patients are asking for,” Freguletti says.
Improving patient outcomes and the lives of patients and their families also contributes to clinician well-being. “To know they are involved in something that results in better patient outcomes promotes personal well-being as well as their sense of purpose,” Sparta says. The streamlined nature of robotic surgery and the improved outcomes that come with it contribute directly to reduced costs. For example, decreased blood loss means a reduced need for transfusions. Less risk of infection results in reduced complications and decreased lengths of stay.
“When we look beyond the direct costs associated with robotic surgery, our data for outcome-related metrics actually demonstrates robotic surgery is less costly and more cost-effective than traditional surgical approaches,” Sparta says.
Actionable data allows the organization to make clinically smart decisions that improve its surgical programs. The health system uses internal benchmarking data from its EMR, and Intuitive provides national and international benchmarking data so Hackensack Meridian Health can see how it stacks up to its peers. Getting “granular” with procedure-specific and surgeon-specific data helps further promote program excellence and continuous process improvement.
“To look at everybody who does one type of operation, for example, and compare their outcomes to one another allows you to see where the outliers are—and where the opportunities are,” Stifelman says.
For more information, please contact Samantha Martin, senior marketing manager, U.S. Hospitals, Intuitive, at executive.education@intusurg.com.
Written and published by ACHE