BRIAN KENNY: If you’ve ever questioned why most barbershops have a striped pole exterior, right here’s your reply. For a lot of the first millennia, barbers had been additionally surgeons who supplied bloodletting and suturing along with a trim and a shave. The pole had a brass basin on the high to carry the leeches and one on the backside to gather the blood. Fortunately, because the medical occupation advanced, physicians turned surgical consultants training their specialty in additional appropriate environments. The first sterile working area got here on-line in Germany in 1884, setting the stage for an ongoing stream of improvements and procedures, apparel, tools and expertise that produce miraculous medical outcomes each day. One of the best limitations in our skill to make these outcomes obtainable to extra folks is that so few folks know find out how to do the procedures. So, it appears the best innovation of all could be discovering a technique to have a surgeon be in two locations at one time. Today on Cold Call, we’ve invited Professor Ariel Stern to debate her case entitled, “Proximie: Using XR Technology to Create Borderless Operating Rooms.” I’m your host, Brian Kenny, and also you’re listening to Cold Call on the HBR Podcast Network. Ariel Stern’s analysis focuses on expertise administration and innovation in healthcare, together with the digital transformation of medical expertise, and that’s completely applicable for as we speak’s dialog. Ariel, thanks for becoming a member of me.
ARIEL STERN: Thank you for having me again. It’s great to be right here.
BRIAN KENNY: It’s been some time since we’ve had you on the present, so I’m glad that you simply’re right here to speak about what’s a brilliant attention-grabbing case. We’re listening to a lot as of late about ChatGPT and AI and machine studying and expertise and the best way it’s impacting our lives. I had by no means thought of it within the context of an working room, however what Proximie is doing is de facto attention-grabbing and doubtlessly type of breakthrough by way of the way it can assist humanity out. So, thanks for writing the case, and why don’t we simply dig proper in. Maybe you can begin by telling us what the central challenge is within the case and what your chilly name is to start out the dialogue within the classroom?
ARIEL STERN: Absolutely. So the central challenge within the case, and it’s exactly to what you simply stated, is round how will we construct a enterprise that represents a very novel digital innovation for surgical procedure? And so ,the primary chilly name within the case is de facto an open-ended one, which is asking the scholars to simply inform me what’s the worth proposition of this new expertise and for whom. At a a lot larger stage, the case is about asking all of us to think about and reimagine who might derive worth from a completely new mind-set about performing surgical procedures that’s augmented and supported meaningfully by digital expertise.
BRIAN KENNY: Many of us, of our listeners, have had surgical procedure. So we’ve all been in an working room atmosphere earlier than. It’s clearly intimidating should you’re the affected person. You know you’re surrounded by every kind of devices and expertise. There’s lights and beeps and every kind of issues occurring. Maybe you may describe a little bit bit what a number of the applied sciences are which can be mostly utilized in working rooms.
ARIEL STERN: As you stated, you’re fully surrounded by devices. Increasingly so. There are laparoscopes and all the instruments utilized in non-invasive surgical procedures. There are robots. Actually, I used to be simply having espresso earlier this morning with one in all our MD/MBA alums who was speaking about utilizing the Da Vinci robotic, which is probably the most well-known surgical robotic on a day-to-day foundation. But within the working room, the affected person after which all the healthcare professionals within the working room are simply surrounded by dozens, if not tons of of items of medical expertise, together with digital expertise. And I feel that one thing that’s straightforward to neglect is that till lately, just about none of that expertise was linked to different items of expertise, and definitely to not any type of central infrastructure that would assist us make sense of all the data that was being generated and picked up. And I feel to perhaps skip forward a little bit bit, I feel what’s so exceptional about Proximie is that it’s this technology-neutral platform that enables clinicians, but additionally medical machine professionals, proctors, individuals who could be mentoring clinicians or surgeons by new procedures, to truly see totally different items of expertise in a single place, and to even accomplish that remotely. The Proximie setup entails 4 totally different digital camera angles into the working room. What they’ve finished is that they’ve engineered all the latency out of the digital camera views, which seems to be very important as properly. So Brian, should you and I wish to simply have a convention name to catch up about analysis at Harvard Business School, Zoom is a wonderful software for that. The downside is that there’s a little bit of a delay, and that doesn’t work terribly properly if I’m making an attempt to carry out a fragile and complicated surgical process.
BRIAN KENNY: Yeah. You don’t wish to delay when any individual’s reducing into your scalp or one thing.
ARIEL STERN: That’s proper. So giving any individual who’s distant the chance to expertise a number of views and angles of the working room to take action in actual time, after which to have the ability to use augmented actuality instruments to truly give suggestions, to inform a surgeon, perhaps they’re proctoring a process, to say, “Hey, I would cut here or have a look here,” and to truly zoom in on a picture, circle locations on that picture and truly interact remotely relatively than simply being a passive receiver of that audio and visible is awfully highly effective.
BRIAN KENNY: That is so fascinating, and it will get to what I talked about within the intro about having a physician be in two locations at one time.
ARIEL STERN: Absolutely.
BRIAN KENNY: Because it does seem to be one of many solely limitations on our skill to have higher outcomes for extra folks is simply the quantity of people that know find out how to do the work, proper?
ARIEL STERN: One hundred percent. One hundred percent. And now we have workforce shortages just about in all places in healthcare. I feel it’s significantly acute within the surgical setting. So 5 billion folks, that’s a B. So you heard that proper. Five billion folks worldwide lack entry to surgical procedure and to protected surgical procedure. And the best way that we regularly present surgical care to of us, say in rising markets or in very distant areas, is commonly folks from our hospitals in Boston and from different OACD nations will take surgical missions to different components of the world they usually’ll spend a pair weeks on the bottom. Many of the medical doctors that I do know right here on the town will go fly all the way down to Haiti and carry out surgical procedures there, they usually carry out an unimaginable service to these communities and to a really, very needy set of sufferers. But that doesn’t scale very properly. And what if even some subset of these procedures could possibly be carried out by somebody native with the mentorship and proctorship of any individual who’s sitting in entrance of a pc and has entry to the web right here in Boston?
BRIAN KENNY: Yeah. So that’s an awesome segue into speaking in regards to the founding father of the corporate, Nadine. Can you inform us a little bit bit about her background and perhaps what motivated her to wish to pursue this concept?
ARIEL STERN: When we had been writing the case, we truly took a while to do a bit extra of a protagonist profile than I often do in circumstances. Nadine is known as a exceptional particular person, and by all accounts an unimaginable surgeon. She was born within the United States in a Lebanese-American household, grew up in San Diego, after which as a young person moved again to Beirut, to Lebanon the place she was from, and ended up spending a lot of her early life in postwar Lebanon. And she talks a couple of surgeon, one such surgeon who was doing these visiting excursions and would come by and carried out surgical procedures for a time period, from the US, would come to Lebanon yearly and would take her with him as a young person. And she watched these reconstructive surgical procedures happen that had been simply transformative for folks’s lives. And she stated, “I’m going to grow up to do that,” and did certainly accomplish that. And I feel taking it a step additional, not solely delivering on that promise to develop as much as be a reconstructive surgeon and assist folks, however to take action, however then to construct this firm that enables different surgeons to scale the ability units they’ve is I feel what makes the story actually exceptional.
BRIAN KENNY: Yeah, I’m all the time so amazed, and we hear about this quite a bit truly in Cold Call about individuals who, at a really younger age, type of set that purpose after which they go off they usually do it. It’s all the time spectacular to listen to about that. What would she say is the issue that she’s making an attempt to resolve?
ARIEL STERN: Yeah. At the best stage, she’ll inform you that she goes after this downside of the 5 billion folks worldwide who lack entry to protected surgical procedure. And she and her colleagues are deeply dedicated to the worldwide well being impression that Proximie has the potential actually to ship on. At a type of extra quick stage, there’s a narrative that she instructed us that’s shared within the case about how she got here to her personal private inflection level. She talks about sitting in a footstool, a chilly working room, and on the cusp of one in all these world well being missions and considering, this isn’t scalable. And I feel the quote within the case is she says, “Look, nothing’s digitized, nothing’s connected. If a bus hits me tomorrow, nothing will continue. After all the work I’ve done, there’s no way to scale this.” And she says, she begins considering to herself, “Why do I have to travel? Couldn’t I just scrub in virtually? Why do I have to get on a plane and deal with the jet lag and aren’t there other ways? Surely there’s something that we could do.”
BRIAN KENNY: Yeah, and with expertise, it’s a superbly legit query to ask as of late. We’re all experiencing one another just about in ways in which we by no means have earlier than. But the case additionally alludes to the truth that there are some distinctive challenges to digitizing the expertise in an working room setting. What are a few of these?
ARIEL STERN: Absolutely. And that’s proper. So what’s attention-grabbing in regards to the working room is that though there are various items of digital expertise, as we stated earlier, they’re not truly well-connected to 1 one other. And in lots of respects, for that purpose, the working room itself is the final bastion of the healthcare system of the hospital that’s not digitized. And what Proximie does is definitely attempt to digitally seize two various kinds of knowledge that haven’t been captured digitally prior to now. The first is that this siloed knowledge. So that is the information coming from these OEM machines, these items of kit which can be already digital however not in any other case linked. And so taking these items of siloed knowledge and truly making these usable elsewhere and visual to others, particularly, these exterior of the working room. The second, and I feel that is actually thrilling as a result of that is an space the place simply so little has been finished thus far, is capturing all of this unstructured knowledge from this contextual knowledge occurring alongside the best way because the surgical procedure is being carried out. These are issues like what’s being written on the whiteboards of the working room? Where are folks standing relative to 1 one other? What are they speaking about? And these are options of a surgical procedure that will train us a lot about what works properly, what are the correlates of security? How are the consultants doing this? Perhaps I simply don’t know that the individuals who carry out the easiest surgical procedures on the earth, the place have they got their scrub tech standing relative to the place they’re? What are the issues that they’ve on their whiteboards? And actually making a extra holistic expertise each for lecturers and learners who’re in a position to be a part of that working room remotely. And after all, all this then could be captured on video. This has extraordinary instructional potential and may solely, and as I began off by saying, a part of the explanation I really like this case and I really like this firm, is that it actually invitations us to consider all the ways in which we might create a lot worth by doing a correct digital transformation of a setting in healthcare.
BRIAN KENNY: And I initially considered this as simply, properly, the surgeon’s going to inform the opposite surgeon what to do, and it ends there. But clearly it’s a a lot larger, a lot better potential than that. So one of many issues I’m questioning although is because of this everyone is videotaped, all of their work is videotaped, they’re being watched, and to some extent that will make some folks uncomfortable. I’m questioning how she was in a position to persuade folks to provide this a strive.
ARIEL STERN: This is one thing we’ve been lucky to, once we train this case to the HBS college students, we’ve been very lucky. We’ve had Nadine right here on campus. We’ve had numerous colleagues of her, Bryn Davies, who’s her world advertising and marketing officer who’s talked about within the case as properly, has joined us a pair occasions. Now, it is a query that all the time comes up. It’s type of, what about privateness? What will we do with all this video? Proximie as an organization is being terribly considerate about this. And after all the customers can determine what to do with that video. Should this simply be a dwell process? Should this be captured for numerous functions? Something that I suppose stunned me a bit that perhaps I’ll share with you is the potential of those movies not solely to do the plain issues that we talked about be captured for instructional functions and for coaching functions, persons are like, “Oh, aren’t you worried about being sued?” And it is a query that comes up. I feel one thing that I discovered that’s fascinating is definitely that almost all, in actual fact, the overwhelming majority of lawsuits introduced in opposition to hospitals for ostensible surgical malpractice are sometimes settled as a result of hospitals are unable to show the absence of malpractice. And the suspicion is that truly, by having proof, one might truly think about a world the place surgeons who’re doing their job proper and the hospitals that make use of them are literally type of vindicated in these circumstances, as a result of it’s very tough. Somebody has a surgical process after which has some type of damaging end result. It’s usually very tough to show that the surgical procedure itself was not the trigger or any variety of issues concerned in rehabilitation or simply merely the idiosyncrasies of restoration from a surgical procedure that will result in a nasty end result for a affected person. But type of understanding that the surgical procedure was finished properly and accurately and to a really excessive medical commonplace could possibly be very priceless. So I simply needed to flag that as a result of it was one thing that got here up that stunned me. I feel truly although, lots of the potential on this expertise is to make surgical procedure safer. I imply, the entire level is to not seize dangerous surgical procedures, however relatively to have a rising tide carry all boats to truly enhance schooling, enhance the standard of the surgical procedures which can be occurring, and truly make these surgical procedures higher on common.
BRIAN KENNY: And I might say kudos to all the surgeons that had been prepared to work with Nadine on this to permit the expertise to come back into the working room. And right here now we have the result, which is doubtlessly big. She didn’t do that alone. These issues by no means occur alone. Can you speak a little bit bit about her technique for bringing different companions on board to work on this?
ARIEL STERN: There are numerous methods we might speak about different companions. I feel on one hand, by way of their world well being work, Proximie has been very deliberate and I feel very considerate about discovering companions within the world well being setting. They speak about Jhpiego and Ariadne Labs, whom they’re working with in Kenya. But fascinated by who’re the correct companions for truly launching initiatives and merchandise internationally is vitally essential, discovering these organizations which can be on the bottom that may enable you to scale. The different facet of that is what we speak about within the case, which is that this “Powered by Proximie” technique that they had been embarking on on the time we wrote the case. The case is ready in January of 2022, and it was printed a couple of month, I feel, or two after that. So, it’s an early 2022 case. And Proximie is considering by find out how to companion with the ecosystem of corporations which can be placing tools in working rooms within the first place. And these are sometimes {hardware} corporations and there are producers which can be constructing these built-in working rooms and the tools that’s being put into working rooms. And why not simply companion with them? Why not companion with the telecom corporations which can be very important companions? We haven’t talked about this but, however this expertise working properly actually depends on issues like having community connectivity. So, the case is ready at a time when Proximie has established quite a lot of actually compelling partnerships and is beginning to suppose by, how does this all match collectively? And the tradeoff there that we do speak about within the case, and that is definitely related for Proximie, however related for therefore many different companies, which is what do you lose and what do you achieve while you give a number of the management of scaling your small business to a companion? On one hand, partnering with corporations which can be already in tons of or 1000’s of working rooms looks as if a very compelling technique to scale. Let’s simply press a button. And it’s a software program firm, so that you don’t should ship any tools anyplace. Let’s simply roll out our product into working rooms that have already got tools sitting there that has a software program element. On the opposite hand, you’re placing the destiny of your small business within the palms of others, so that you’re counting on their success. This, in lots of respects, has the charming function of really being a reasonably conventional enterprise technique query. So I feel that’s fascinating. Another set of questions the case raises greater than it solutions is round Proximie’s digital and knowledge technique. I feel that is fascinating on this inevitably results in such a wealthy dialogue with the scholars once we speak about it, which is that they’re capturing all this knowledge that beforehand has been uncaptured as a result of it’s been both siloed or contextual and uncaptured, and what can we do? What can we do with this knowledge? And so I feel, and also you began to go there along with your questions, however I feel these are actually the attention-grabbing strategic questions that face the corporate.
BRIAN KENNY: And lots of that will get to what their future imaginative and prescient is for the corporate itself. And I might think about that there are challenges to scaling as a result of it is a firm, this product relatively, requires tools. So you’ve bought to have folks which can be offering that. It requires entry to technological experience. So how are they fascinated by a few of these challenges going ahead?
ARIEL STERN: Yeah, and also you requested in regards to the future imaginative and prescient. I imply, you speak to any of them, they are saying, “Look, our vision is to be in every operating room in the world. there’s no reason not to have this.” I feel the flip aspect of that query is, “Why would you not want this technology in every operating room in the world?” But definitely they face many particular challenges to this context. You have to grasp, how do you do gross sales to hospitals? What are the type of humorous, I might say, nuances of entering into a number of, do it’s important to go hospital by hospital or not? Thankfully for Proximie, there are there methods to work with built-in supply networks, which could be a conglomerate of tons of of hospitals. So you get one in all them enthusiastic about your technology-
BRIAN KENNY: And they’ll take off.
ARIEL STERN: … and you’ll take off. So there are challenges round scaling that, there are questions round how do these partnerships, both with medical machine corporations, medical expertise corporations, or with different sorts of organizations, slot in right here? Where this in the end finally ends up is a very wealthy dialog that’s particular to this firm, however in the end grappling with these fairly typical enterprise technique questions round…
BRIAN KENNY: They sound much like lots of different cases-
ARIEL STERN: … lots of different circumstances, proper? You have to grasp how issues are offered to hospitals and the way expertise makes its means into working rooms. But on the finish of the day, do you companion? Do you not companion? When do you go world? What are your beachhead markets?
BRIAN KENNY: Ariel, this has been an awesome dialog. I knew it will be, and clearly what Proximie is doing might doubtlessly have big impression on folks in all places. I hope they obtain the imaginative and prescient that they’ve got down to obtain. If there’s one factor you need our listeners to recollect in regards to the case, what wouldn’t it be?
ARIEL STERN: Yeah, it’s about digital transformation in healthcare. And I feel simply taking a very large step again and remembering that digital innovation and digital transformation in healthcare entails rethinking what’s potential. And so usually in healthcare, we take into consideration digitizing stuff we have already got. Let’s take well being information and make them digital. Let’s take surgical procedures and take a video of them. But take a giant step again and let’s rethink what’s potential due to the digital applied sciences that we’re bringing into our healthcare supply system.
BRIAN KENNY: And the subsequent time you go in for surgical procedure, if there’s a bunch of cameras round, don’t freak out.
ARIEL STERN: Don’t freak out. You’re truly most likely going to have a safer, higher-quality surgical procedure, perhaps with the skilled enter of any individual who’s not bodily current within the room.
BRIAN KENNY: That’s nice. Ariel, thanks for becoming a member of me.
ARIEL STERN: Thank you for having me.
BRIAN KENNY: If you take pleasure in Cold Call, you would possibly like our different podcasts, After Hours, Climate Rising, Deep Purpose, IdeaCast, Managing the Future of Work, Skydeck, and Women at Work. Find them on Apple, Spotify, or wherever you pay attention, and should you might take a minute to price and assessment us, we’d be grateful. If you will have any ideas or simply wish to say hi there, we wish to hear from you. Email us at coldcall@hbs.edu. Thanks once more for becoming a member of us. I’m your host, Brian Kenny, and also you’ve been listening to Cold Call, an official podcast of Harvard Business School and a part of the HBR Podcast Network.
