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Advancing Tomorrow in the Operating Room of Today

The Surgeon-Innovator’s Dilemma

A recent debate between Dr. Michael Rosen and Dr. David Earle in General Surgery News appeared prescient given findings published soon thereafter that minimally-invasive surgery is associated with decreased survival in the surgical management of cervical cancer

As the surgical community reacts to this news and reflects on the role of innovation and technology in surgery, the debate outlines a useful framework for the discussion. Both reaffirm the importance of high-quality evidence and remind us that patient-relevant outcomes must inform the science. 

Earle goes further to pose surgery’s “chicken or the egg” quandary—would some of the fields’ most important innovations have survived rigorous, win/loss evaluations early on in their development cycles?

These questions lie at the heart of the surgeon-innovator’s dilemma—how can the profession best balance the careful craft of apprenticeship with the rigor of scientific inquiry?  Picking winners and losers on day one is indeed hard work, but inquisitive minds and a commitment to continued, careful evaluation provides the selection pressure required for true winners to emerge.

We don’t fear surgery quite like we used to

We applaud generations of surgeons, who, already well-trained in their craft, uprooted their practices and careers to train on laparoscopic (and then again, robotic) techniques in a pursuit to mitigate the pain and suffering that was a staple of surgical care.  We, as patients, don’t fear surgery quite like we used to.

The same innovative spirit led many to develop early natural orifice approaches. And although “NOTES” in its infancy failed to gain widespread adoption, new techniques like TaTME and Antigravity ESD riff on some of its basic concepts to offer real benefits to patients. Failing forward.

I recently worked with a colorectal surgeon at a major health system to win system-wide approval of our CleanCision technology. During their initial evaluation, they found that it had reduced their SSI rates, and we worked together to successfully navigate the purchasing and contracting process. The process seemed obfuscating by design, and we initially joked that it must have been due to our “rookie” status in these matters.

I’ve since learned that many surgeons view the process itself as a major deterrent to the adoption of innovative new technology and procedures, which can only impede their pursuit of excellence. This is a troubling development. Surgeons are uniquely and solely entrusted with the agency of patient care, mens et manus. If they don’t do it, no one will.

A delicate and difficult balance

Providers and payors have struggled to balance the potential benefits of new technologies with costs. Structural shifts in the healthcare system have diminished the appetite for new technology adoption. With provider consolidation, clinical innovation takes a back seat to standardization, efficiency, and the cost pressures of housing payor and provider under the same roof. With these forces at work, hospital-employed surgeons face an uphill battle to harness the promise of new technology.

The reality is that these shifts are going to continue. So how does the surgeon-innovator thrive within this environment?

Top seven insights from the front lines

As we’ve worked with surgeons to implement CleanCision into infection control protocols, we’ve learned a lot from our real world experience in navigating the adoption of new technology in today’s operating room:

1. Strong clinical value proposition (improved safety and/or efficacy), validated by stakeholders beyond the requesting surgeon or even his or her surgeon peers. With outcome measures like post-operative infection, for example, service line nursing leaders, wound care nurses, and infection control leaders can be important advocates for approval and tracking results

2. Equally important, a strong economic value proposition and cost-savings model demonstrating tangible ROI

3.  Evidence, evidence, and more evidence—peer-reviewed publications are par for course, and local evidence even better to convince stakeholders the technology works “here in the real world”

4. Go “beyond the budget” by tying outcomes to broader strategic initiatives that have visibility at the executive level (e.g. hospital acquired infection, patient satisfaction, etc.)

5.  Don’t go it alone. While most hospitals require the requesting surgeon to fill out new product request forms, surgeons should leverage their industry partners to ensure they are providing a comprehensive package for evaluation.

6. Be patient and engage your industry partner as they pursue pricing & contracting discussions, and remember that periodic reminders from the requesting surgeon (esp. upcoming surgeries) can help expedite the administrative processes.

7. Set mileposts for evaluating success—did the results match our expectations? Encourage industry sponsors to support the modest funding needed to conduct such evaluations. You may be surprised how even the smallest startup ventures are willing to do this!

This list is the beginning of what I hope will be a running list of useful real world insights. So, please share any thoughts and I’ll add them to the list!

Thank you for continuing to be champions of innovation and advancing the standard of care for your patients.