1. The Angers University Hospital created a hybrid room that combines operating room capabilities with high-quality imaging to enable minimally invasive surgical procedures. 2. A hybrid room allows different surgical specialties like cardiology, vascular surgery, and neurosurgery to perform minimally invasive procedures guided by imaging technology. 3. Creating the hybrid room required significant investment but will provide patients an advanced option for complex procedures with less risk of post-operative complications. It also requires new organization and training for medical teams.

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minuteISSUE 1 VOLUME 14 SUMMER 2015
The MarkeTech Group
INTERVIEW OF THE SEMESTER
Hybrid room: At the root of hybrid room creation.
Mr. Yann Bubien (YB)
Director of Angers CHU
INTERVIEW
Interviewer: Julien Regnard (JR), TMTG Partner
JR: It is with pleasure that I welcome today Yann Bubien, Director of the University Hospital (CHU) of Angers who acceptedto
share a specific experience within the Angers University Hospital, the creation of a hybrid room.
Sharing this experience will continue throughout 2015 and will include 4 major phases: the project birth, its implementation, a
first activity report and a perspective with similar projects in the United States or France.
Let’s get startedwith this interview of Mr. Bubien, I thank him for his involvement in this project.
The aim of our conversation today will be to define what a hybrid room is and to understand the reasons that led the
University Hospital of Angers to develop such a tool.
For our hybrid room, the medical project
was conducted in conjunction between the
radiology - the room will be under the
control of the chief of radiology-, the
cardiac surgery, the cardiology, the
vascular surgery and the neurosurgery.
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INTERVIEW
JR: Mr. Bubien, hello, my first question is actually quite simple, what is your definition of a hybrid room?
YB: Hello,I don’tknow if there is a strictdefinition of a hybrid room but it is clear that for the Angers University hospital a hybrid
room is a room that musthave specifications to perform surgical procedures using in priorityminimallyinvasive surgical
techniques that rely heavily on imaging.
Therefore, a hybrid room mustbenefitfrom air handling compatible with an operating room,optimal imaging qualityand obviously.
The room musthave all the characteristics of an anesthesia area.
There are other University Hospitals who alreadyhave hybrid rooms within the lastyears with Lille and Tours or Nancy; Angers
University hospital will be among the firstinstitutions ofFrance to provide such environmentfor patients and professionals .The
particularity of the Angers’ project is to have integrated the hybrid room in the interventional imaging area by bringing together
three operating theaters.The architectural dimension ofthis space was particularlyshaped with the creation of suitable premises.
The whole implementation is scheduled for September 1st
this year.
One of the hybrid room characteristics ofthe Angers University Hospital is to provide differentsurgical specialties,which use the
room;a particularlypowerful imaging system in a space thatcan easily"alter" in conventional surgeryif needed.This space of
about100m2 promotes the integration oftechnologyto come.At the University Hospital several surgical specialties will occu r in
this room:the heart surgeryof course but also vascular surgery,interventional cardiologyand neurosurgery.
Therefore, it should be understood thatthe hybrid room is not an architectural and equipmentrestructuring,but has above all been
designed as a new patientpathway; a path that changes and involves a new organization between doctors,anesthetists and
radiologists who have to work differently within the hybrid room.
In a nutshell,here is our hybrid room projectat Angers university hospital!
JR: How did you come up to consider the implantation of such a room?
YB: The idea was not born at the Angers University Hospital,italready exists abroad in major centers that adapttheir
technologies to contemporarymedicine;they inspired us.Our will and our mission as UniversityHospital is to maintain a hig h level
of expertise, so we need to adaptto medical innovation and make available to the public this medical excellence that
characterizes a University hospital.
It is now clear that the future of surgerywill increasinglyinvolve a combination ofminimallyinvasive su rgeryand imaging
techniques.
Also, the patients care in the hybrid room will provide mini-invasive surgerywith high quality. Performed under 2D/3D imaging and
fusion imaging - imaging thatcombines scanner,MRI, ultrasound with real-time imaging,equipmentin place will prevent, in many
cases,the use of a heavier conventional surgery.
By making it easier,the complexprocedures while reducing post-operative complications,this advanced technologywill allow to
bring an optimal response to the need for an aging and fragile population.
The hybrid room,is both a technological adaptation and a new organization by combining surgeryand imaging while offering
patients a mini-invasive procedures.
JR: You spoke of difficulties that may arise in the teams’ organization, is the clinical component the core of the
implementation of this project kind? Is this a joint approach with the teams?
YB: I think this is really an institution policy; it cannotjustbe the University Hospital director wishing implementati on;ifthere is no
medical projectbehind,itdoes not make sense.
In fact, there is necessarilya conjunction between the will of the general direction to go to such a tool, the desire to bui ld or adapt
an existing building,the will to buy equipmentthatis quite expensive and the will of medical and paramedical staffto provide
patients advanced service involving internal organization changes.
For our hybrid room,the medical projectwas conducted in conjunction between the radiology - the room will be under the control
of the chief of radiology-, the cardiac surgery, the cardiology,the vascular surgeryand the neurosurgery.
It is a brand new organization; new practices are in the process ofbeing set.Radiologists and surgeons will work together i n the
institution’s medical committee.
This new room also involves paramedical staffreorganization.It is a jointwork for a different care path. In my opinion,th is is a
solution for the future.

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JR: Is this kind of tool led to replace in a sustainable way the current practices or alternatively will both coexist, hybrid
room becomes a complementary tool in the " surgical tools’ box"?
YB: For now it is the coexistence between the two approaches thatprevail,the hybrid room is an additional tool in a complexarray
of equipmentand practices.
It is possible thatother technologies emerge,buteither way I’m sure we are heading to the less and less invasive acts wher e the
alliance between surgeryand imaging will be more tenuous;itis a radical evolution of radiology in recent years.
JR: In consideration of the numbers of constraints we also understand the need to adapt staff training.
CA: I have told you, we work to optimize the overall functioning upstream ofthe room’s opening.The room w on’tbe opened until
September 1st
2014, so it is difficult to tell you from now how will it happen in the field.
It is clear that we will be led to make organization’s readjustments according to actual operation.
In fact, it is necessaryto overhaul existing medical and paramedical organizations and also strengthen skills;Ithink particularlyfor
radiologytechnicians (manipulators),nurses,IBODEs,the IADEs, caregivers.
Everyone has new skills which mustbe assimilated;physicians such as allied health professionals;this is also a very interesting
collective projectbecause itis always rewarding to update together,as a team, practices and gain new skills in this occasi on.
JR: What is the impact for the CHU from an economic and financial point of view?
YB: It is a first-rate investment.Beyond the acquisition ofequipmentand adaptation ofits environment,it had to reckon with the
architectural investment;we have builtan extension to one of our buildings.It is a heavy investmentbut an inve stmentfor the
future. I'm sure it will work.
For the youngestphysicians and as for paramedics,Ithink it's very exciting to have such tool available. There is no doubt patients
will also be very demanding.
JR: Does the thought of brand image affect the decision to invest in such a project
YB: Sincerely no. I will not tell you that it is not interesting,butthe real benefits in terms of brand image don’timpactthe decision
to launch this kind of project.
The lead is the medical projectwhich is part of an institution project;and there is nothing else that matters.What counts is that
physicians will wantto do something together on a defined project,in this case,the hybrid room;and there is a match betwe en the
institution projectand its ambitions for the future, its general policyfor the years to come.
At CHU of Angers, the brand image is builton our reality; it is builton who we are and what we offer to the population.The re is no
question ofreversing the process.However,we mustrecognize that in France, there aren’tmany hybrid rooms yet, and even
fewer hybrid rooms as we have conceived in Angers.We bring the innovation,this one can only be a promise for our image and of
course we are going to sell it.
What really matters is to respond to a growing need for patients in this new way to operate. One more time,the brand image
doesn’tmean anything ifit doesn’twork,if the team can’t get along with one another,if we can’t organize the works betwee n
physicians and paramedics.
JR: Does that meanyou don’t predict a rapid democratization to other kinds of institutions? I think of the general
hospitals or even the private ones?
YB: I don’tknow, it is a relatively expensive investmenton surgical and imaging specialties rather within the public service.
Cardiac surgeryand neurosurgeryare almostexclusivelydone in the public.This could take place in the private sector and i n
some general hospitals butitis a big investment;to use it requires having health professionals adequatelytrai ned to operate the
system.Moreover, such equipmentis a tool for research.
If the economic model rather meets the need ofa CHU, I don’t see why the other institutions cannotacquire this kind oftool .
In 5 to 10 years, I think this practice will develop, other types of institutions will probablygetequipped.
INTERVIEW

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MEASURING the VOICE-OF-CUSTOMER in HEALTHCARE
INTERVIEW
JR: Referring to the industrial partners involved in the project, is it principally the traditional operating rooms’ industrials
or rather the medical imaging partners?
YB: I prefer not to commenton that because itis not me who has led the projecton these aspects.I only followed the institutio n
and medical projectside.Biomedical engineers took care of this.
From my pointof view, everything went well,we are on time,and the works are done properly.
JR: In terms of future hybridization projects of surgery rooms in France, do you have a visibility of the institutions in
reflection on this subject?
YB: I don’thave the visibility on other projects.As far as I know,CHU have or are currently being deployed such rooms with
sometimes differentpositioning ofAngers project.In this regard,let your readers know thatthe CHU organized an inauguration on
September 25.
JR: Mister Bubien, Thank you very much for these clarifications in Angers project.
Appointment is made with the CHU of Angers for the next step of this experience sharing, in September for an
explanation of the room implementation.
Thank you one more time and see you soon.