Utilizing Human Factors to Improve Surgeons’ Data Access

Abstract

Improving health care quality has been a focus for human factors practitioners in the past decades. Built on the new computerized information provided by Robot-Assisted Surgery (RAS), we conducted interviews with 21 surgeons to explore how this surgical information can help improve surgeons’ efficiency and proficiency. Almost all the participants we interviewed considered their surgical data access to be limited. In addition, they indicated that insights from surgical data could help improve their efficiency and proficiency. We present our findings in two main categories: the surgeons’ current data access and the tools surgeons use to access surgical data. We also documented what surgical data surgeons need, why they need the data and how the data could help improve surgeons’ efficiency and proficiency. Our findings and proposed designs were incorporated in My Intuitive App designs to implement values identified by our Human Factors analysis.

Objectives

Improving health care quality has been a focus for human factors practitioners in the past decades (Catchpole et al., 2019; Kanji et al., 2021). Built on the new computerized information provided by Robot-Assisted Surgery (RAS), we conducted interviews with 21 surgeons to explore how this surgical information can help improve surgeons’ efficiency and proficiency.

There are two types of surgical data which all our participants considered to be helpful. The first type of surgical data are clinic outcomes, such as length of stay, complications, readmissions, and cancer cured or not. Another type of surgical data are case characteristics, including case time, case volume, procedure types and instrument choreography. Robot-Assisted Surgery enables those computerized case information tracking automatically and then can be provided to surgeons.

Almost all the participants we interviewed considered their surgical data access to be limited. In addition, they indicated that insights from surgical data could help improve their efficiency and proficiency. We present our findings in two main categories: the surgeons’ current data access and the tools surgeons use to access surgical data; we also documented what surgical data surgeons need, why they need the data and how the data could help improve surgeons’ efficiency and proficiency. Only a few of participants have access to their surgical data via the database in American College of Surgeons (ACS) or log case data in excel spreadsheet currently. Most participants consider that clinic outcome data and case characteristics data can be used to identify opportunities to improve their surgical skills. All participants commented that they wish to have easy access to more data so that they can know how well they are doing, where they are on their learning curves, and what can be done differently to improve their efficiency and proficiency.

Our findings and proposed designs were incorporated in My Intuitive App designs to implement values identified by our Human Factors analysis.

Method

Participants

To explore current surgical data access practices, we conducted semi-structured interviews with 21 participants (14 men, 7 women) who have various RAS experience. We sought a diversity of RAS experience in our participants so that our findings can represent RAS surgeons in general. Participants were independently recruited through professional connections with Intuitive Surgical, Inc. These 21 participants represented six specialty surgeons (General surgery, Colorectal surgery, Bariatrics, Urology, Cardiology, and Gynecology) whose RAS experience was between 1 and 12 years.

Data Collection

All interviews were conducted by one of the co-authors of this paper. Twelve interviews were conducted in person and nine interviews were conducted over desktop video conferencing. Interviews were conducted face-to-face, usually at the conference rooms in Intuitive Surgical office buildings or mobile lab. Interviews lasted approximately 90 minutes and participants were compensated for their time according to fair market value and processed according to legal requirements. All payments were appropriately disclosed in accordance with applicable transparency requirements. All interviews were video-recorded and reviewed for analysis. Observations from the interviews were first open coded for recurring themes, then analyzed by comparing specific instances of those themes across the participants.

Besides collecting demographic information and the nature of their RAS practices, the interviews asked about their current surgery data practices and needs. We probed specifically about what data they use to improve their surgery efficiency and proficiency, and how the data could help them and the use cases of surgical data. Participants were invited to freely comment on their surgical data experience.

Findings

Lack of Surgery Data Access

Two out of 21 participants reported that they use the database from American College of Surgeons (ACS) to log their surgery. They can pull out case volume from ACS for credentialing purpose. One participant shared that she uses excel spreadsheets to track her cases. She documented her case time, case volume, and other case characteristics for her own record. One participant shared that his hospital provides a quarterly report to surgeons. The report includes individual surgeon’s case volume, case time, and some clinic outcome data, such as complications. Most participants don’t have easy access to surgical data. Half of the participants assumed that they could access these data if they ask hospitals to provide them and haven’t done that yet because they assume that it’s not easy and they are too busy to explore it. And half of the participants wish they could access surgical data easily and have no clues how they can access the data.

Leveraging Surgery Data

Most participants indicated that they could use clinical outcome data such as complications to identify opportunities to improve their surgical skills. They also consider case time, one of case characteristics, as an objective measurement of their efficiency. They look at case time trend to assess if they become more efficient and gain proficient overtime. A few participants commented that case time shouldn’t be measured for their performance because surgeons should be safe rather than fast. However, all participants indicated that patient safety is their top priority; they don’t perform surgery fast just to be fast. Shorter case time is the result of their efficiency improvement. Another case characteristic, instrument choreography is also identified as helpful by our participants in practices of surgery optimization and standardization, which has been promoted by hospitals.

Takeaways

Our interviews of participants in six specialties documented the variety of surgical data and use cases to improve surgeons’ efficiency and proficiency. Despite the usefulness of surgical data, all participants considered their current data access to be limited. They also mentioned that surgeons have the spirit to improve their surgical efficiency and proficiency throughout their surgical career no matter how senior they are. Clinical outcome and case characteristics data are key metrics for surgeons to evaluate their efficiency. It will help surgeons to improve their surgical skills with a result of improving health care quality if surgical data and insights can be easily accessed by surgeons. We implemented these surgeons’ needs in our digital My Intuitive App which provides RAS case characteristics data to registered surgeons.

Our study examined surgeons’ data access practices and needs at an early stage of its development. As Robot-Assisted Surgery continues to develop, we expect that surgical data access will become more common and more surgeons will benefit from the use cases we identified. We expect that our proposed design implements will start an iterative process of identifying and meeting surgeons’ data access needs. In particular, while our study found a persistent value of surgical data access, more research is needed to explore new technologies to enable easier data access for surgeons to improve their practices with the aim of improving health care quality.