Factors supporting and constraining the implementation of robot-assisted surgery: a realist interview study

Abstract

ObjectiveTo capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice.DesignA literature review provided tentative theories that were revised through a realist interview study. Literature-based theories were presented to the interviewees, who were asked to describe to what extent and in what ways those theories reflected their experience. Analysis focused on identifying mechanisms through which robot-assisted surgery becomes integrated into practice and contexts in which those mechanisms are triggered.SettingNine hospitals in England where robot-assisted surgery is used for colorectal operations.ParticipantsForty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists.ResultsInterviewees emphasised the importance of support from hospital management, team leaders and surgical colleagues. Training together as a team was seen as beneficial, increasing trust in each other’s knowledge and supporting team bonding, in turn leading to improved teamwork. When first introducing robot-assisted surgery, it is beneficial to have a handpicked dedicated robotic team who are able to quickly gain experience and confidence. A suitably sized operating theatre can reduce operation duration and the risk of de-sterilisation. Motivation among team members to persist with robot-assisted surgery can be achieved without involvement in the initial decision to purchase a robot, but training that enables team members to feel confident as they take on the new tasks is essential.ConclusionsWe captured accounts of how robot-assisted surgery has been introduced into a range of hospitals. Using a realist approach, we were also able to capture perceptions of the factors that support and constrain the integration of robot-assisted surgery into routine practice. We have translated these into recommendations that can inform future implementations of robot-assisted surgery.

Stakeholders’ views on the organisational factors affecting application of artificial intelligence in healthcare: a scoping review protocol

“…These stakeholders have different and sometimes conflicting interests and perceptions on the benefits, risks, opportunities and limitations of integrating AI in healthcare. 3 9 There have been several scoping and systematic reviews capturing these various stakeholders’ perspectives on implementing AI in healthcare, 2 3 9 but they are mostly focusing on clinical outcomes and individual factors shaping AI adoption. However, none of these reviews focused on the wider organisational factors that can facilitate or hinder successful implementation of AI in the sector.…”

“…17 The authors jointly concluded that adequate funding would overall incentivise healthcare organisations as the introduction of AI requires significant financial expenditures and changes to operational processes. 3 10 17 18 Another reported organisational issue is related to a perceived loss of clinician control and autonomy, as some healthcare workers are concerned that policymakers, insurers, and administrators may use technology as a way to influence clinical decision making and actions. 18 Some studies also reported that the absence of a clear legal framework and relevant policy developments, especially when it comes to data protection and accountability for the care outcomes, can serve as potential organisational barriers for successful adoption of AI.…”

Determinants of the implementation of an artificial intelligence-supported device for the screening of diabetic retinopathy in primary care – a qualitative study

“…56 At the same time, it appears to be essential to include all participating parties in the process of implementation from the beginning. 57 To prevent tensions between ophthalmologists and GPs, it is essential to enhance communication between both parties and to share information. It should be communicated that a DR screening in primary care should not be a replacement but an addition to the existing system.…”

Roboethics principles and policies in Europe and North America

“…Since we can expect robots and humans to co-exist and collaborate, fostering trust for autonomous robots would be fundamental to their ability to perform their tasks. Policymakers will need to be cognizant of public's perspectives and implement effective strategies in launching human-robot co-working arrangements [64].…”