Texas Institute for Robotic Surgery delivers better care with data

Driving performance with data

Tableau: What have you learned since adopting Tableau?
Randy Fagin, MD, VP Robotic Surgery: I think one of the most important things that we've learned in delivering care is that you would ask what do we measure, what can we measure that other folks aren't measuring?

Exceptional care is not just about experience. There are operational things that we can do that we learn using things like Tableau, using this real time data, that lets us create exceptional care and scale that to a degree that we could never do if it was just based on experience alone.

Telling somebody that they're not as good as this other hospital down the road is nowhere near as valuable as saying, if you want to be like that do these three things. And that's really what Tableau has allowed us to do.

Tableau: What kinds of data do you have?
Randy: Looking at 98 hospitals, looking at 30,000 procedures per year, what's the same by surgeon, by procedure, by nurse type, and how can we leverage that to deliver better care?

There are core behaviors that, not just behaviors, but I would say there are core disciplines that people put in place in their lives that are just kind of how they exist that actually result in a whole bunch of downstream endpoints. And what we've been able to do with Tableau that I've never seen anybody do with any other mechanism is to find out what are those core disciplines, those core behaviors that don't drive one performance metric, they drive 30 performance metrics.

The ability for us to interact with the data the way that we want it was completely transformational.

To be able to dig down not to the level of what we're looking at, but kind of the things that are causing what we're looking at, that's unique. And that's not something that we were able to do before Tableau came along.

Tableau: What was it like before Tableau?
Randy: The difference between the way that we looked at the information before and now, if I look at my ability to do ask and answer questions and the distance between that ask and that answer, now versus before, just in the last three years of our using the product, yes, I've saved years of my life waiting for information.

Exceptional care is not just about experience. There are operational things that we can do that we learn using Tableau, using this real time data, that lets us create exceptional care and scale that to a degree that we could never do if it was just based on experience alone.

Creating cultural change—with data

Tableau: What’s one important factor in health care?
Randy: One of the things that we look at are delays, delays at getting a patient to the operating room, whether it's a delay in an emergency room getting a patient from the front door to a doctor, whether it's a delay in the operating room getting a patient from the pre-op area into the operating room. Delays impact our ability to deliver exceptional care. And we all have hunches on what we think causes those delays.

So when you start to hear a group of individuals all kind of pointing in the same direction saying, we believe that this is the reason why our customers have a delay between what they want and what they receive, we were able to actually dig in, in a very short period of time to figure out whether that was real and then be able to act on it.

And I'll tell you the most interesting and important part of that was we didn't have to take any we didn't have to change a process. We didn't have to take any punitive action against anybody. All we had to do was to take the information we had learned on the cause of the delay, transparently, and just make that information available.

I'll tell you, the ability to deliver real time transparent information to people is transformational. Behaviors change. They change just based on being able to see in real time what's going on.

This is not last quarter's results. This is not last week's results. This is not even yesterday's. This is what's happening right now.

Real time information, real time knowledge, creates real time accountability. And our ability to deliver quickly and rapidly change in an environment to make sure that our care is exceptional, man, real time accountability you can't beat that.

Turning a surgeon into a data analyst

Tableau: What’s the biggest change for you personally since using Tableau?
Randy: I think the biggest thing that Tableau offered was the ability for somebody like me, I'm a surgeon by training and I've kind of transitioned to the healthcare management field. I'm not a statistician. I've got no background in mathematics outside of what I did in college. And to be able to be the person with no intermediary between myself and understanding the data, that was critical. In all of the other data solutions that we looked at, I needed to request a data query. I needed to have somebody to review that for me, to create that chart, whatever it was, and interact with them in a way that allowed me to read it. It was too much delay between what I wanted and when I was able to get it. And Tableau shortened that gap to nothing. It allowed me to actually be able to in real time interact with the data and answer questions with nobody in-between me and the information.

Tableau: What’s the value of powerful data analysis to you?
Randy: It's not anecdotal, because Tableau allows us to integrate so much information in real time, all at once, the anecdotal stuff washes out. If it's noise we're going to see as much above the line as we do below the line. The anecdotal stuff just washes away when the N is big enough. And what you see are real trends. And when you see a real trend you go, holy cow, that's amazing. Let me check this other one. Not next week, not in a report that somebody will pull for me, but right now, like sitting at this table. Let's figure this out while we're here talking.

Tableau: Can you tell us more about the logistics of robotic surgery?
Randy: So robotic surgery with da Vinci is the transformation in medicine and our ability to deliver exceptional care to patients in the operating room in surgery. And as robotic surgery, as da Vinci surgery has evolved, it is no longer just one machine for one type of operation. There are multiple different iterations of the machine. There are dozens if not hundreds of different operations that we can do with that. And as a result it means that we don't have a one-size-fits-all solution when it comes to things like capacity or performance or being able to deliver exceptional and efficient care.