By Samit D. Soni, MD
Urologist, Memorial Hermann Memorial City Medical Center, Houston, Texas
In my recent move to a new position at a different hospital, I knew I was leaving behind some surgical tools I had spent 4 years using and teaching to residents and fellows. It can be unsettling to start using different tools – we’re all creatures of habit – but this was not a deal breaker for me because I knew that over time I could convince my new hospital that the benefits of the newer technologies make them a wise purchase.
If you are starting somewhere new or planning a move and you want to have certain technologies in your new facility, you can often make a strong case if you truly understand the clinical benefits to the patient and the economic benefits for the hospital. Here are three tips from my experience:
1. Be assertive. Early in my moving process, I decided it was best to be assertive with my “needs” and “wants” in order to perform my job well earlier in the process, rather than asking after several years of using the existing equipment. Make your case while you have their attention as a newer surgeon. Bear in mind you were hired for your skill set and up-to-date knowledge of the latest techniques and technologies. Every hospital has capital earmarked for certain expenditures, and if your service is not vocal about getting technology that will benefit patients and the hospital, then you could miss your opportunity.
Although the older equipment may have gotten the job done for the past 20 years, the economics of healthcare today rely heavily on efficiency and safety. However, it is also important to have a clear understanding between your “needs” and “wants” when deciding which pieces of technology to target first.
2. Lay out the clinical benefits. Hospitals are built to serve the community through the knowledge and skills of their medical staff. If you believe a piece of equipment will significantly improve patient care, then clearly outline the clinical benefits to your new facility. In my situation as a urologist, I believed that a new Holmium laser (Lumenis Pulse 120H with Moses Technology) would significantly improve OR efficiency and surgical outcomes. I reviewed the current literature with the hospital administration and OR staff and explained the clinical benefits of investing in such a technology. We could dust kidney stones more effectively, thus improving stone-free rates with reduced anesthesia time, particularly for large stones. Furthermore, the Moses technology reduces retropulsion of distal ureteral stones, and may therefore reduce scope trauma (and need for ureteral stenting).
3. Make the economic case. Any new piece of technology needs to have economic benefits to make it palatable for a hospital or surgery center. Perhaps the argument could be a reduction in operating room times, or the technology would facilitate usage of fewer unreimbursed disposables and equipment. In the case of the Moses technology, reduced retropulsion when fragmenting distal ureteral stones may help avoid opening a flexible ureteroscope to chase it up the ureter or kidney.
Furthermore, most hospitals strive to remain at the forefront in their treatment offerings in the modern ultra-competitive healthcare landscape. For my part, I researched and outlined the technologies available at other local and regional hospitals and showed how such a new technology could set my hospital apart from the competition. Access to new gadgets also can be a boon for hospitals interested in recruiting and keeping their talented surgeons.
Taken together, these arguments for hospital investment in new surgical technology are very strong, and they can work very effectively when used in an organized and convincing manner. Don’t hesitate to make the same kind of case as I did to get the surgical technology your patients deserve.
In my post-fellowship job search, the facilities’ technology and equipment carried a lot of weight. I had trained with exceptional leaders in my field, and I wanted to utilize the same surgical platforms I had used in my fellowship training, particularly the latest standard in advanced laparoscopic and robotic laser excision of endometriosis.
Although many facilities are, understandably, not yet using the most advanced medical equipment, I found that many are receptive to conversations around future purchases. Those practices are the ones I targeted in my search. It was insightful to have an open dialog with their purchasing departments to understand how much and how frequently they invest in new surgical equipment. I appreciated the practices that sought my input on not only the tools I prefer to use, but also why I had a preference for them. It demonstrated an environment of collaboration and growth.
It was clear that many forward-thinking practices want to advance their capabilities. I found it refreshing when practices sought insight on the newest technologies from incoming physicians who were trained with the latest tools. I’m grateful that includes the practice I joined. One of the reasons I was hired was my background in advanced minimally invasive gynecologic surgery, including the use of the CO2 laser (Lumenis UltraPulse DUO with FiberLase). Now I look forward to helping advance the technology we need to further build that aspect of the practice.
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