A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

Randell, Rebecca; Honey, Stephanie; Hindmarsh, Jon; Alvarado, Natasha; Greenhalgh, Joanne; Pearman, Alan; Long, Andrew; Cope, Alexandra; Gill, Arron; Gardner, Peter; Kotzé, Alwyn; Wilkinson, D. S.; Jayne, David; Croft, Julie; Dowding, Dawn

doi:10.3310/hsdr05200

Cited by 32 publications

(43 citation statements)

References 176 publications

(257 reference statements)

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“…A robot is ‘a reprogrammable, multi-functional manipulator designed to move materials, parts, tools, or other specialised devices through various programmed motions for the performance of a variety of tasks’. 1 Medical robots are increasingly used for a variety of applications in clinical medicine 1–4 such as laparoscopic surgery, 5 surgical training, 6,7 rehabilitation 8,9 and assistive personal care. 10,11 Furthermore, robots have been used for non-patient-orientated purposes, such as medical cleaning, automated medication delivery and transport of equipment.…”

Section: Introductionmentioning

confidence: 99%

Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats

et al. 2019

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Background: Medical robots are increasingly used for a variety of applications in healthcare. Robots have mainly been used to support surgical procedures, and for a variety of assistive uses in dementia and elderly care. To date, there has been limited debate about the potential opportunities and risks of robotics in other areas of palliative, supportive and end-of-life care. Aim: The objective of this article is to examine the possible future impact of medical robotics on palliative, supportive care and end-of-life care. Specifically, we will discuss the strengths, weaknesses, opportunities and threats (SWOT) of this technology. Methods: A SWOT analysis to understand the strengths, weaknesses, opportunities and threats of robotic technology in palliative and supportive care. Results: The opportunities of robotics in palliative, supportive and end-of-life care include a number of assistive, therapeutic, social and educational uses. However, there are a number of technical, societal, economic and ethical factors which need to be considered to ensure meaningful use of this technology in palliative care. Conclusion: Robotics could have a number of potential applications in palliative, supportive and end-of-life care. Future work should evaluate the health-related, economic, societal and ethical implications of using this technology. There is a need for collaborative research to establish use-cases and inform policy, to ensure the appropriate use (or non-use) of robots for people with serious illness.

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Section: Introductionmentioning

confidence: 99%

Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats

et al. 2019

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“…RE is recommended for studying QI23 and has been used for studying the implementation and impact of large-scale QI programmes 24. There is increasing interest in use of realist methods in feasibility evaluations 25–27…”

Section: Methods and Analysismentioning

confidence: 99%

How, in what contexts, and why do quality dashboards lead to improvements in care quality in acute hospitals? Protocol for a realist feasibility evaluation

et al. 2020

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IntroductionNational audits are used to monitor care quality and safety and are anticipated to reduce unexplained variations in quality by stimulating quality improvement (QI). However, variation within and between providers in the extent of engagement with national audits means that the potential for national audit data to inform QI is not being realised. This study will undertake a feasibility evaluation of QualDash, a quality dashboard designed to support clinical teams and managers to explore data from two national audits, the Myocardial Ischaemia National Audit Project (MINAP) and the Paediatric Intensive Care Audit Network (PICANet).Methods and analysisRealist evaluation, which involves building, testing and refining theories of how an intervention works, provides an overall framework for this feasibility study. Realist hypotheses that describe how, in what contexts, and why QualDash is expected to provide benefit will be tested across five hospitals. A controlled interrupted time series analysis, using key MINAP and PICANet measures, will provide preliminary evidence of the impact of QualDash, while ethnographic observations and interviews over 12 months will provide initial insight into contexts and mechanisms that lead to those impacts. Feasibility outcomes include the extent to which MINAP and PICANet data are used, data completeness in the audits, and the extent to which participants perceive QualDash to be useful and express the intention to continue using it after the study period.Ethics and disseminationThe study has been approved by the University of Leeds School of Healthcare Research Ethics Committee. Study results will provide an initial understanding of how, in what contexts, and why quality dashboards lead to improvements in care quality. These will be disseminated to academic audiences, study participants, hospital IT departments and national audits. If the results show a trial is feasible, we will disseminate the QualDash software through a stepped wedge cluster randomised trial.

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“…but communication is required for a good interacting team 22 to obtain the best possible surgical results and outcomes for the patient. 23,24 When a robotic system is introduced in this established situation, significant changes in professional roles, interactions, and communication can be expected, 24,25 furthermore the former team interaction is radically changed into a team-machine interaction. 22,26 Possibly, there will also be changes in surgical procedures, due to the requirements of robotic systems.…”

Section: The Surgical Viewpointmentioning

confidence: 99%

Robotic Systems in Operating Theaters: New Forms of Team–Machine Interaction in Health Care

et al. 2019

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Background Health information systems have developed rapidly and considerably during the last decades, taking advantage of many new technologies. Robots used in operating theaters represent an exceptional example of this trend. Yet, the more these systems are designed to act autonomously and intelligently, the more complex and ethical questions arise about serious implications of how future hybrid clinical team–machine interactions ought to be envisioned, in situations where actions and their decision-making are continuously shared between humans and machines. Objectives To discuss the many different viewpoints—from surgery, robotics, medical informatics, law, and ethics—that the challenges of novel team–machine interactions raise, together with potential consequences for health information systems, in particular on how to adequately consider what hybrid actions can be specified, and in which sense these do imply a sharing of autonomous decisions between (teams of) humans and machines, with robotic systems in operating theaters as an example. Results Team–machine interaction and hybrid action of humans and intelligent machines, as is now becoming feasible, will lead to fundamental changes in a wide range of applications, not only in the context of robotic systems in surgical operating theaters. Collaboration of surgical teams in operating theaters as well as the roles, competencies, and responsibilities of humans (health care professionals) and machines (robotic systems) need to be reconsidered. Hospital information systems will in future not only have humans as users, but also provide the ground for actions of intelligent machines. Conclusions The expected significant changes in the relationship of humans and machines can only be appropriately analyzed and considered by inter- and multidisciplinary collaboration. Fundamentally new approaches are needed to construct the reasonable concepts surrounding hybrid action that will take into account the ascription of responsibility to the radically different types of human versus nonhuman intelligent agents involved.

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A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

Cited by 32 publications

References 176 publications

Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats

Robotic technology for palliative and supportive care: Strengths, weaknesses, opportunities and threats

How, in what contexts, and why do quality dashboards lead to improvements in care quality in acute hospitals? Protocol for a realist feasibility evaluation

Robotic Systems in Operating Theaters: New Forms of Team–Machine Interaction in Health Care

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