da Vinci速 Surgery Implementation A Plan for Building and Managing a Successful da Vinci Surgery Program
Introduction The da Vinci® System is the most technologically advanced surgical platform available in today’s market.
As a result, more and more hospital executives are using the da Vinci System to improve patient outcomes and satisfaction, attract new patients and fulfill their organization’s mission to be the community’s leading healthcare provider.
With da Vinci Surgery, physicians can offer standard-of-care treatment with the potential benefits of a minimally invasive procedure — and with potential outcomes that Effective management of da Vinci Surgery as a service are equal to or better than line and smooth implementation of a comprehensive conventional surgery.
Simply acquiring the da Vinci technology is an incomplete solution for program are essential to maximizing value — clinically, achieving this mission. strategically and financially. Seamless integration of As patients learn about a new technology into the advantages of the daily operations of surgeons, OR staff and hospital da Vinci Surgery, many are now asking for it by name. administrators is challenging. Effective management of da Patients appreciate the value of an effective procedure Vinci Surgery as a service line and smooth implementation of performed in the least invasive manner possible. a comprehensive program are essential to maximizing value — clinically, strategically and financially. Since it was first introduced more than a decade ago, the da Vinci System has been adopted worldwide in a range of This programmatic approach to da Vinci Surgery program specialties beginning with cardiac and general surgery, and implementation requires joint leadership across key progressing through urology, gynecology, thoracic and head functions, carefully constructed strategic plans, partnership & neck surgery. An estimated 1 million da Vinci procedures between the customer and Intuitive Surgical and ongoing have been performed worldwide, providing a broad base of assessment. patients with effective, minimally invasive treatment.
Hospitals are using da Vinci Surgery to improve patient outcomes and satisfaction, attract new patients and fulfill their mission to be the community’s leading healthcare provider.
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da Vinci® Surgery Implementation Plan
A Blueprint for Success The da Vinci® Surgery Implementation Plan brings together best practices gained from the development and implementation of hundreds of da Vinci Surgery programs worldwide. Based on experiences with a variety of programs, we have found four best practices critical to building a highly successful da Vinci Surgery program:
Coordinate Operations and OR Team
Manage as a Program with Multidisciplinary Leadership
Educate Your Community
• Form a da Vinci Surgery Steering Committee with strong executive leadership and physician involvement, and hold a kick-off meeting • Set objectives, strategies and metrics for success
• Once you see the clinical outcomes you expect, begin spreading the word • Promote your da Vinci Surgery offering with a website, PR, patient and referring physician education and a targeted media campaign • Coordinate community education efforts with da Vinci surgeons’ practices
Establish the Clinical Pathway
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• Identify committed and dedicated surgeons to guide and grow the program • Create a clinical plan and credentialing requirements defining system and procedure training
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• Hire/appoint a da Vinci Coordinator responsible for overseeing the system utilization and staff education • Train the entire OR team to successfully manage da Vinci Surgery
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da Vinci® Surgery Implementation Plan
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Manage da Vinci Surgery as a Program ®
Establish a da Vinci Steering Committee To successfully manage da Vinci Surgery as a program or service line, it is important to establish a multi-disciplinary da Vinci Steering Committee. The role of the steering committee is to: • Set da Vinci Surgery Program goals • Develop a clinical plan and conduct ongoing review of clinical results • Coordinate hospital departments and OR operations • Create marketing plan for patients, referring physicians and hospital staff This group may include: • da Vinci Surgery Director: A senior surgeon who has a good working relationship with hospital administration, department chiefs and the OR Director. It is important that this person be committed to and actively involved in the da Vinci program. • Department Chairs whose specialties will be actively involved in the program implementation • OR Director/OR Supervisor • da Vinci Coordinator • Marketing Director • Senior administration representative – e.g., CEO, CFO
The da Vinci Coordinator is the primary custodian of the da Vinci System
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da Vinci® Surgery Implementation Plan
Set your objectives, strategy and metrics for success. Hospitals that successfully implement a da Vinci Surgery program begin with a business plan that addresses strategic, clinical and financial objectives. They look at their baseline data and establish realistic, measurable goals and associated deadlines to track and measure program success. They create a clinical plan and credentialing requirements defining System and procedure training. The plan should answer the following questions: • How does da Vinci Surgery complement your MIS program across surgical specialties? • Have you benchmarked your existing goals? • How will you measure success? • Improved clinical outcomes • Improved quality and safety • Additional MIS procedures • Program growth
m with Multidisciplinary Leadership Many of the most successful academic and community hospitals with da Vinci Surgery programs have strategically When establishing the budget for your da Vinci program, planned for the adoption of the technology across account for: multiple specialties. They positioned da Vinci Surgery as • Support staff, particularly a da Vinci Coordinator an enabling technology for multiple procedures rather • Operational expenditures than a single procedure. This comprehensive approach has • Marketing to promote your da Vinci acquisition and strengthened the competitive positioning of their da Vinci clinical outcomes Surgery programs in their respective Establish a beachhead, Successful hospitals set their sights on proficiency in a single da Vinci procedure and then execute to the clinical marketplaces. then bring in multi-
Establish a budget
specialty reinforcement plan with speed and efficiency. Successful hospitals establish a beachhead in their market. This means that Continuously review and assess your progress they set their sights on proficiency in a single da Vinci • Track goal progress during regular steering committee procedure and then execute to the clinical plan with meetings speed and efficiency. This targeted approach tends to help • Conduct 90-day business development meetings with hospitals build technical proficiency more quickly. your Intuitive Surgical representatives to monitor your progress and adjust your strategy if necessary.
Establish your program by developing a beachhead procedure and then bring in multi-specialty reinforcement.
da Vinci® Surgery Implementation Plan
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Establish the Clinical Pathway Successful programs require engaged, da Vinci-trained surgeons to guide and grow the program. To help surgical teams achieve clinical proficiency in the safest and most efficient manner possible, surgical credentialing, privileging and a clinical pathway should be established from the outset.
Intuitive Surgical developed the da Vinci Surgery Clinical Pathway based on years of experience training and integrating teams of surgeons and OR staff. • The da Vinci Surgery Clinical Pathway can offer a template useful for new or experienced surgical staff who want to develop a da Vinci OR team or optimize team proficiency. • It is recommended that teams use the Pathway to complement credentialing requirements.
The da Vinci Surgery Clinical Pathway is divided into four distinct phases, with reinforcing activities for both surgeons and OR staff: Phase
I: II:
Introduction to da Vinci Surgery
Content
Trainer
Product Training
Intuitive Surgical
Clinical Training
Independent Surgeons & Societies/Academic Institutions
Preparation and System Training
III: Post System Training
IV: Advanced Training
Beyond the Pathway
Continuing Clinical Education
Independent Surgeons & Societies/ Academic Institutions
Phases I-II of the Clinical Pathway are dedicated to product training, while phases III-IV are dedicated to clinical training. Beyond the pathway, clinicians and staff hone their skills with continuing clinical education, including courses and symposia offered by independent surgeons, academic institutions and professional societies.
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da Vinci® Surgery Implementation Plan
Product Training • Phase I: Training activities are initially focused on building familiarity with the da Vinci System. This includes on-line System training modules and observing live procedures to learn about clinical applications and techniques. • Phase II: Surgical teams participate in on-site and offsite training, which provide a hands-on System skills development.
Create program goals and track metrics of efficiency/ competence. Examples include: • Time from da Vinci installation to training; time from training to first da Vinci procedure • Time to complete the initial 20-case series (often referred to as the learning curve) and reach the recommended minimum of 1-2 da Vinci procedures per week • Operative time and OR turnover time
Continue evaluation after each initial case and commit to Clinical Training continuing education • Phase III: Focuses on building System and clinical Surgeons who successfully adopt the da Vinci approach competence through the surgeon’s initial da Vinci invest in their skills and budget for additional education procedures. and skills training. This phase begins with a team procedure dry run before Intuitive Surgical is committed to supporting the first procedure to allow your efforts in building an effective da Vinci a final review of roles and Surgery program. responsibilities. • Phase IV: The Training Pathway does not end after Hands-on Urological Robotic Training Course the initial case series. Advanced da Vinci training in multiple specialties led by experienced, independent da Vinci surgeons is available through select training centers.
Clinical Pathway
LOW ANTERIOR RESECTION
da Vinci Test Drive
da Vinci System Certificate Training
dVLAR Case Observation
da Vinci Procedure: Rectopexy (2-5 cases)
da Vinci Procedure: Sigmoid or Right Colectomy (For benign disease or early stage tumor) (2-5 cases)
Surgeon-Led Training (Recommended)
A network of da Vinci gynecologic surgeons is available for case observation and proctoring in both the US and EU
da Vinci Procedure: Hybrid LAR (Robotic rectal dissection) (10-15 cases) Advanced LAR Course (Recommended)
da Vinci Procedure: Fully robotic Dual Docking LAR (10-15 cases)
Wednesday 29th June, 2011 8 am - 5 pm University College London Hospital State-of-the-Art Surgical Training Centre • • • •
Understanding the equipment Confident set-up Efficient and safe assisting How to get your operative times down
Course Director:
Mr. Jim Adshead, Consultant Urologist, Lister Hospital
Faculty:
Prof. John Kelly, Consultant Urologist, UCL da Vinci Procedure: Mr. Conrad Bishop, Robotic Fellow, Lister Hospital Fully robotic Single Docking LAR Mr. Bijan Khoubehi, Consultant Urologist, Chelsea Westminster Ms. Gillie Basnett, Surgical Practitioner, UCL Mr. Matt Perry, Consultant Urologist, St Gerorge’s Mr. Ben Challecombe, Consultant Urologist, Guy’s This file is for general information only and is not intended to substitute for formal medical training or certification. Independent surgeons, who are not Intuitive Surgical employees, provide procedure descriptions. Intuitive Surgical trains only on the use of its products and is not responsible for surgical credentialing or for training in surgical procedure or technique. As a result, Intuitive is not responsible for procedural content. While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, individual results may vary. ©2010 Intuitive Surgical, Inc. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, Dynamic Coronary Artery Stabilization™ capability, InSite, and EndoWrist are trademarks or registered trademarks of Intuitive Surgical, Inc. PN 871937 Rev. D 12/10
Class size is limited. Register now at: //www.uchmas.org/robotics_da_vinci.php
Training Pathway tools and programs are available from Intuitive Surgical Important Considerations To develop and maintain proficiency, hospitals must ensure their surgical teams quickly and systematically follow and execute on their clinical pathway. Below are some additional suggestions for successful execution of the Clinical Pathway:
Identify a Proctor Select a proctor with experience necessary to support surgeon learning. Intuitive can supply you with a list of independent surgeon proctors. Create an outcomes database to assess physician performance and program quality • This tool enables the hospital to conduct ongoing assessment and develop performance improvement plans. • The database may include metrics such as intra-operative performance and outcomes e.g., blood loss, conversions, length-of-stay and post-operative quality-of-life measures. da Vinci® Surgery Implementation Plan
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Coordinate Operations Establish OR leadership structure The successful integration of a da Vinci System into the operating room is dependent upon strong OR leadership and operational efficiency. OR Leadership should be established in order to: • Support physician and operating room team competency, development • Build da Vinci procedure efficiency while maintaining safety • Allocate and manage block time for surgical specialties and surgeons
Evaluate and standardize operating room activities To prepare for the integration of da Vinci into the operating room, it is important to assess and modify (as appropriate) operating room space to ensure efficient workflow and successful procedures. • Operating room layout, instrument usage and team roles and responsibilities should be identified and standardized to optimize quality and efficiency. • This OR efficiency strategy should also include identifying tasks that can be performed simultaneously and assigning them to team members.
Appoint a da Vinci Coordinator
This person is the primary custodian of the da Vinci System and is responsible for its inventory, preparation and maintenance. In addition, the da Vinci Coordinator is responsible for scheduling, streamlining turnover times and System training.
Identify and build the initial surgical team
Begin by training one team and only train more personnel after the first team is established. • Ensure that committed physicians and OR staff follow the Clinical Pathway as a team. • Include anesthesiologists in training specific to da Vinci procedures to support greater OR efficiency, particularly during the initial learning curve. • Educate support staff, including ICU and recovery teams, on post-operative treatment for da Vinci patients as compared to traditional surgical patients. • Ensure OR staff have access to continuing education programs like the da Vinci Coordinator Course, First Assist Course and OR Efficiency.
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da Vinci® Surgery Implementation Plan
OR Efficiency Tools and programs are available from Intuitive Surgical
Educate Your Community Develop a comprehensive community education plan At the outset of any da Vinci program, every hospital must create and implement a comprehensive community education plan. The objective of this plan is to raise awareness among a broad audience, beginning with hospital boards, staff and employees followed by referrers, patients and the community.
For more information on da Vinci web-based education resources, please visit the da Vinci Online Community, www.davincisurgerycommunity.com
In the beginning, communication will be primarily to your staff and professional community and focus on your reasons for acquiring this new technology. Once you are comfortable with your clinical outcomes, it is appropriate to start communicating to a broader audience. The following table lists promotional activities that are fundamental to a successful community education plan: Audience
Tactic
All Audiences • Hospital staff • Referring physician • Patients/Caregivers • Media
• Website update • Prominent presence on website homepage • Multiple links to daVinciSurgery.com • Develop advertising around da Vinci Surgery program
Hospital Staff Audience
• Employee Open House/System Test Drive • Administration • All employees • Hospital Foundation/Board System Test Drive
Referring Physician Audience
• Identify target markets • Identify referrers in primary, secondary, tertiary markets • Schedule referring physician events, dinner presentations to introduce da Vinci surgeons
Community Audience (Local and extended community outreach)
Evening or weekend Women’s or Men’s Health community programs
Media Audience
• Press release • System acquisition • Establishment of minimally invasive da Vinci Surgery program
Execute an internal communications plan Upon System acquisition, a community education launch should begin by building awareness among internal audiences and educating audiences on da Vinci Surgery’s potential benefits as they relate to the hospital’s strategic initiatives. • Typical mediums include: letter from the CEO to staff, newsletters, intranet, open house and community outreach event(s) • Educate call center representatives, referring physicians, foundation and board members
Plan and execute a media campaign • Keep a local/regional focus, and highlight patient stories • Do a press release and video release • Host a media day with System test drives • Do follow-on campaigns for individual specialties • Tie your da Vinci program to other national health observances e.g. for cancer, Leverage the da Vinci Surgery Marketing Toolkit: chronic conditions, athletic Resources are available on fundraising events, etc. the Online Community
Support surgeons by conducting referring physician and patient education seminars • This should begin once the surgical teams have completed a number of successful cases • The lead surgeon’s goal should be to give at least one physician seminar and one patient seminar each quarter
Measure the return on your community education investment • Measure awareness before and after the start of a campaign by tracking media mentions • Gauge your organization’s reputation in the community before and after a campaign using surveys • Document changes in physician referral patterns
Build a public-facing website or micro site that • Educates the community, your target markets • Brands your hospital as a world-class da Vinci Surgery center • Steers patients to your center • Contains at least one patient story linked from daVinciStories.com • Is optimized and cross-linked to daVinciSurgery.com da Vinci® Surgery Implementation Plan
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Partnership with Intuitive Surgical Behind every successful da Vinci Surgery program is a strong partnership with Intuitive Surgical. Through the implementation of da Vinci programs around the world, Intuitive Surgical has acquired the experience and expertise to facilitate development of a comprehensive and productive da Vinci program. Intuitive Surgical offers a full complement of tools and resources designed to support your program’s success. Resources available to da Vinci customers include:
• da Vinci Surgery Implementation Plan: Provides the framework and work plan for a program launch
• Genesis Program:
A team dedicated to helping launch successful da Vinci Surgery programs by improving OR efficiency, building procedure efficiency and training clinical support teams
• da Vinci Surgery Comprehensive Clinical Pathway: Designed to ensure optimal safety, efficacy and utilization of your da Vinci System
• da Vinci Surgery Online Community:
A secure social networking site designed to support peer-to-peer discussion and access to educational materials
• Comprehensive da Vinci Surgery Hospital Marketing Programs: Tools and ideas for educating your community • Intuitive Surgical Health Policy Department: Available to answer questions regarding reimbursement, coding considerations, coverage decisions and technology assessment
Please do not hesitate to contact anyone from the Intuitive Surgical, Sales, Training and Marketing organizations for assistance as you develop and execute your da Vinci Surgery program. The success of your da Vinci Program is our highest priority, as our goal is to extend the benefits of minimally invasive surgery to the broadest base of patients. Thank you for your support and commitment to da Vinci Surgery and to improved patient care.
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da Vinci® Surgery Implementation Plan
Worldwide Headquarters 1266 Kifer Road, Building 101 Sunnyvale, CA 94086-5304 Tel: +1.408.523.2100 Fax: +1.408.523.1390 European Headquarters Intuitive Surgical Sàrl 1, chemin des Mûriers 1170 Aubonne, Suisse Tel: +41.21.821.20.00 Fax: +41.21.821.20.01 Asia Pacific Headquarters Intuitive Surgical Sàrl Shanghai Room 2051, 20th Floor No. 989 Chang Le Road Shanghai 200031 P.R. China Tel: +86.21.5116.6881 Fax: +86.21.5116.6899
www.IntuitiveSurgical.com www.daVinciSurgery.com To contact a representative or receive additional information, visit www.intuitivesurgical.com or call Intuitive Surgical Customer Service in the U.S. at 1.877.408.3872, in Europe at +41 21 821 20 00 or +800 0 821 20 20 or in the rest of the world, 1.408.523.2100.
As with any program, individual results may vary as the implementation of the da Vinci Surgery program is practice- and hospital-specific. This does not imply any guarantee of results in practice or program success following da Vinci training. The da Vinci Surgical System should be used only by surgeons who have developed adequate robotic skills to perform the tasks associated with each procedure and who have received specific training in the use of the da Vinci Surgical System. Training provided by Intuitive Surgical is limited to product education on the da Vinci Surgical System and does not replace the necessary medical training and experience required to perform surgery. Intuitive Surgical does not provide clinical training nor does it provide or evaluate surgical credentialing or train in surgical procedures or techniques. Before performing any da Vinci procedure, physicians are responsible for receiving sufficient training & proctoring to ensure that they have the skill & experience necessary to protect the health & safety of the patient. For technical information, including full cautions & warnings on using the da Vinci System, please refer to the System User Manual. Read all instructions carefully. Failure to properly follow instructions, notes, cautions, warnings & danger messages associated with this equipment may lead to serious injury or complications for the patient. While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, individual results may vary. All persons depicted are models. © 2011 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S HD, InSite, TilePro, Single-Site and EndoWrist are trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective holders. PN 871455 Rev. A 05/11