Bringing new robotic and navigation technologies to a spine practice presents a learning curve for surgical teams as well as the surgeons.
Spine surgeons discuss the steps they take to make adding new technologies easier for everyone in the operating room
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
Next question: What can spine surgeons do to address the learning curves with learning any new surgical technique?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, Oct. 23.
Editor's note: Responses were lightly edited for clarity and length.
Question: How can spine surgeons make the transition easier for staff when adding new technologies?
Paul Celestre, MD of Norton Leatherman Spine (Louisville, Ky.): Spine surgery is a team effort. New surgical procedures are uniquely challenging because multiple people in the room, including the surgeon, may be unfamiliar with the flow of the new surgery, including using different instrumentation, implants, and potentially vendors. Foresight and repetition are key to the incorporation of new surgical procedures into one's practice. Before undertaking a new surgical procedure, I would strongly recommend having all participants take place in a hands-on cadaveric lab where the surgery is performed step-by-step multiple times. This will allow all key participants to identify and anticipate intraoperative challenges. On the day of surgery, the surgeon, anesthesiologist, scrub technician and nurse, vendor, as well as any assistants should again review the steps of the surgery before the patient is brought to the room. If necessary, the surgeon can post a written plan on the wall to facilitate communication and understanding. Ultimately, no new procedure will go perfectly smoothly the first time, but with proper team preparation, unforced errors can be minimized.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The best option for staff and new tech is communication. Many of us are lucky enough to have dedicated spine or neurosurgery teams. Quite a few colleagues have to cobble a team together, especially for emergencies. New tech brings uncertainty and opportunities for mistakes to happen. It is important that the surgeon captain the ship and know what he or she wants. ust reaching out your hand isn’t going to cut it with new-fangled devices. The best thing you can do is know what you want and explain it. Before the time-out, when everyone is still setting up, it’s best to go over the trays and the stuff you will need. I even go so far as to pull the eight or so instruments I will need for the case. Honestly, it’s rare to need everything in the trays for every case. Also, tell the team the order in which you plan to do stuff. Try to pick out the usual suspects, tell everyone the plan, and help de-stress your team.
Jeffrey Kachmann, MD. Spine surgeon in Frisco, Texas: Education of staff is critical for new technologies. Generally speaking, the company itself responsible for this technology first educates the surgeon, followed shortly thereafter, his staff. This can be accomplished by courses that the company sponsors that we attend or by in house educational sessions. Certainly the surgeon needs to work closely with staff as well, guiding them along patiently. It's truly a team effort.
Philip Louie, MD. Virginia Mason Franciscan Health (Tacoma, Wash.): It all comes down to establishing the vision and being transparent. When spine surgeons introduce new technologies, we play a critical role as leaders in making the transition smooth for their teams, in fact we should take ownership of this transition. It’s essential for surgeons to share the vision and purpose of these innovations from a big-picture perspective, helping staff understand not just how, but why these technologies are being adopted. We know with any new technology (or anything new in life), there will be early obstacles, challenges, and significant troubleshooting. When the entire staff believes in the mission and understands the long-term benefits—improved safety, efficiency, and/or patient outcomes — they are more likely to push through the inevitable obstacles and challenges with greater commitment.
Transparency in discussing the goals and potential hurdles of the new technology fosters trust in the process. Assigning specific roles to different staff members that align with their passions and skills will further build a collaborative atmosphere, empowering the team to embrace the changes and potentially shorten the learning curve!
Joseph Schwab. MD. Cedars-Sinai (Los Angeles): In a professional setting, no one likes surprises. As surgeons, we rely on our staff to prepare the operative environment for seamless patient care. This involves substantial preparation on the staff’s part, much of which goes unnoticed when things run smoothly. However, when things don’t go well, we often feel "surprised" and disappointed.
Incorporating new technology disrupts the normal workflow and adds stress to both the system and the staff managing it. If staff members are not informed in advance, it sends the message that they are not valued as part of the team. This can lead to frustration and contribute to burnout. To avoid these issues, it’s crucial for surgeons to involve the team in discussions about the new technology early on.
Explaining the purpose of the technology and how it will improve patient care helps set the stage for a smoother transition. Attending in-service training alongside the staff fosters team spirit and ensures everyone understands the potential challenges. If concerns arise during these meetings, the surgeon should work actively with the team to address them.
Conducting a "trial" or "pilot case" is another effective step to ensure the integration process is seamless. It provides an opportunity for feedback and fine-tuning, and the surgeon's involvement in these adjustments is key. Finally, celebrating the successful incorporation of the new technology reinforces team cohesion. This can be done by highlighting improvements in patient care or simply thanking the staff for their efforts.
Ultimately, everyone shares the same goal: providing excellent patient care. This is only possible through mutual respect and true teamwork.
Kushagra Verma, MD. DISC Sports & Spine Center's Marina del Rey (Calif.) ASC: When implementing new technologies, I think it's important for the provider to first do a deep dive and understand all the logistics of implementing each particular technology. New ideas are often shiny and exciting, but the logistics can be overwhelming, and sometimes the potential benefit is not as impressive as one would hope.
My approach has always been to heavily research new ideas, get multiple opinions, and then have a team meeting with my staff to discuss the idea as well as the logistics around implementing that idea. We then usually start with a small trial and a three-month period where we implement the new technology and also critically evaluate it for any pitfalls and problems. After a period of three to six months, we make a team decision on whether or not to continue that course or revert back to our previous methods.
I also think new technologies are exciting in spine surgery, but can sometimes be industry driven, so it takes experience and knowledge of the technology to decide if it's right for your practice.