From the moment patients register at Memorial Sloan Kettering Cancer Center’s new $300 million, state-of-the-art outpatient surgery center on the Upper East Side of Manhattan, they will be taking part in a test bed for emerging ideas in patient experience design, health care technology and data tracking.
Instead of waiting in a long line to register, patients at the new center, the Josie Robertson Surgery Center, will be handed plastic tracking badges that will broadcast their locations in real time, allowing intake coordinators to come directly to them wherever they are sitting. Inspired by modern hotel lobbies and co-working spaces, the family waiting room has semiprivate seating areas and mobile device charging stations. And for people who become antsy while their loved ones are in surgery, there is an Xbox nook for fitness activities.
Operating rooms, too, incorporate “the most advanced technology,” according to marketing materials, including the latest surgical robots and “super-high-definition monitors” to display anatomical imaging.
Other innovations, while seemingly sensible, could have unintended consequences. For one thing, administrators intend to update the traditional practice of asking patients to walk around soon after surgery. They say they plan to use patients’ locator badges as activity monitors, allowing medical teams to quantify and analyze the distances patients walk. It is a step that may make some patients feel more in control of their recovery — while others may feel more burdened by the added surveillance.
“We don’t know what the data means, because no one has ever measured it before,” Dr. Brett A. Simon, an anesthesiologist who is the director of the surgery center, told me in an interview this month at the new building. Still, he hopes the novel data might eventually be used as a benchmark to help distinguish patients who are recovering on schedule from those who have pain or other symptoms that need to be managed.
“Maybe there’s a predictive value,” Dr. Simon says.
Or maybe, like billions of other data points collected by devices, the distance measurements will prove to be mere noise.
Across the country, leading medical centers are trying new approaches to technology and information management with the aim of increasing efficiency, reducing costs and assuring health care quality. Because competition to attract patients is fierce, some of the same medical centers are also engaged in a marketing arms race to out-tech one another, promoting their new tools and systems with terms like “most advanced,” “pioneering” and “cutting edge.”
But this race to innovation, bioethicists say, has created a gray area. While federal regulations require researchers to obtain patient consent for participation in clinical trials for novel drugs and devices, hospitals can freely enact internal quality improvement exercises without consent — even if there might be consequences for patient care. Medical centers typically do not inform patients every time they use them to test some new health app, or nursing staff reduction, or data analysis technique — changes that may or may not ultimately benefit the patient’s health.
“It is clearly a blurry space,” says Nancy Kass, a bioethics professor who is the deputy director for public health at the Johns Hopkins Berman Institute of Bioethics in Baltimore. “It doesn’t matter if it’s quality improvement or research. The questions we should be asking are: Should we be talking about it? What should we be telling patients about it? What do we know about it that makes us think that it works? What do we know about it to suggest that it is safe, or might be risky, or have some uncertainties?”
Administrators at the Josie Robertson outpatient surgery center describe it as a laboratory for continuous improvement, a place where doctors, nurses and staff will be encouraged to rethink standard practices and try new techniques to improve patient care. This learning lab approach comes after a multiyear innovation effort at the main Memorial Sloan Kettering campus, also on the Upper East Side.
A few years ago, administrators there instituted a quality improvement program to determine which patients could be discharged the day after their surgeries, instead of spending several nights in the hospital. The effort was based on the premise that patients tend to recover better at home, where they are more comfortable and less likely to develop infections.
So teams of medical experts set about standardizing certain routines, like the sets of tools surgeons used during prostate cancer surgery. And they identified certain traditional practices — like putting fluid drains in patients after prostatectomy operations — that could be eliminated without diminishing patients’ health outcomes. With such efficiencies in place, doctors say they were able to safely shorten the recovery time to one night in the hospital for selected patients undergoing certain breast, gynecologic, head and neck, or prostate cancer surgeries.
So far, about 10,000 patients have gone through the program. But doctors typically do not tell patients that they have been selected for a more streamlined approach to surgical recovery, Dr. Simon says. That is because the actual surgery and medical treatments patients receive have not changed, just related practices.
“We don’t say to them, ‘You are in this program,’ ” Dr. Simon explained, “We say, ‘This is what your care is going to be like.’ ”
Starting next month, doctors at the Josie Robertson center will perform those cancer surgeries as short-stay outpatient procedures. And administrators say they plan to use the center to further hone their approach, although Dr. Simon said they have not yet decided how they are going to explain the continuous improvement techniques to patients.
For instance, the surgery center has done away with some standard medical practices — such as having a designated postoperative recovery unit where specialized nurses monitor patients coming out of anesthesia. Instead, patients will go directly from surgery to private rooms where cross-trained nurses will monitor their recovery from anesthesia.
“The leadership saw this as an opportunity to be a little bit distant from the big-box academic medical center, to test out new work flows, to test out new technology,” Dr. Simon says. “It’s a learning lab for new systems.”
In health care, however, newer does not necessarily mean better for every patient. If medical centers choose not to be transparent about how they are testing improvements, patients may never learn about results that may directly relate to their care.
For instance, Memorial Sloan Kettering administrators have data indicating that elderly patients in the quality improvement program had a higher chance of not being ready to go home the day after their surgeries. At the new center, doctors will study whether additional measures, such as geriatric consults for patients over 75, will improve their chances of a shorter stay.
The Josie Robertson center is clearly introducing novel health care approaches that may significantly enhance its patients’ experiences. But given the fact that Memorial Sloan Kettering is a world-renowned institution that many other medical centers tend to follow, it seems remarkable that administrators there have yet to pioneer an equally innovative system for transparently communicating their improvement endeavors to patients.
Dr. Simon says he is working on it.
“We do want to communicate the things we are doing that are new and that improve the patient experience without making them feel alarmed or that they are experimental animals,” Dr. Simon said. “I’m not sure we have 100 percent figured out how to do that.”