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Cited by 57Health Policy Implementation ScienceSurgical Simulation and TrainingMinimally Invasive Surgical Techniques

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

Open access
Randell, Rebecca, Honey, Stephanie, Alvarado, Natasha, Greenhalgh, Joanne, Hindmarsh, Jon, Pearman, Alan, Jayne, David, Gardner, Peter +3 more·2019·BMJ Open
DOI 10.1136/bmjopen-2018-028635PMC PMC6589012
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Abstract

Objective: To capture stakeholders’ theories concerning how and in what contexts robot-assisted surgery becomes integrated into routine practice. Design: A 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. Setting: Nine hospitals in England where robot-assisted surgery is used for colorectal operations. Participants: Forty-four theatre staff with experience of robot-assisted colorectal surgery, including surgeons, surgical trainees, theatre nurses, operating department practitioners and anaesthetists. Results: Interviewees 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. Conclusions: We 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.

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  • A dedicated and stable team in which members were selected and trained together in the use of a new surgical technique led to quicker uptake and better integration into practice.

    “Another study found that a dedicated and stable team in which members were selected and trained together in the use of a new surgical technique led to quicker uptake and better integration into practice, theorizing that dedicated and stable teams increased trust, motivation, and collaborative problem-solving [81].”

    From Teamwork and implementation of innovations in healthcare and human service settings: a systematic review (2024) · cites this paper as [81]

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  1. [13]Pawson R, Tilley N Realistic evaluation. London: SAGE Publications, 1997.

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Authors
Randell, R., Honey, S., Alvarado, N., Greenhalgh, J., Hindmarsh, J., Pearman, A., Jayne, D., Gardner, P., Gill, A., Kotze, A., & Dowding, D.
Affiliations
  • University of Leeds (GB)
  • King's College London (GB)
  • Leeds Teaching Hospitals NHS Trust (GB)
  • Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  • University of Manchester (GB)
Corresponding author
Randell, Rebecca
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-06
Volume
9
Issue
6
Pages
e028635
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2018-028635
PMC
PMC6589012
OpenAlex
W2947772928
Cited by
57
References
44
Citations by year
2026: 2 · 2025: 16 · 2024: 13 · 2023: 13 · 2022: 4 · 2021: 6 · 2020: 3
FWCI
4.43
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bradford Scholars (University of Bradford) (publishedVersion, other-oa)
  • Research Explorer (The University of Manchester) (publishedVersion, cc-by)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • HighWire Press Open Archive (submittedVersion)
Funders
Health Services and Delivery Research Programme
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Surgery › Surgical Simulation and Training
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
Keywords
robotic surgery, colorectal surgery, surgical workforce, teamwork, employee training, hospital management support, operation duration, stakeholder perspectives
MeSH terms
Change Management, Procedures and Techniques Utilization, Colonic Diseases, Education, England, Humans, Organizational Innovation, Patient Care Team, Social Perception, Staff Development, Digestive System Surgical Procedures, Needs Assessment, Robotic Surgical Procedures

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