Dr. Nadine Hachach-Haram of Proximie: “Don’t be too reactive”

Don’t be too reactive. Running a medtech startup, any startup for that matter, is a bit of a rollercoaster. You’re going to encounter bumps in the road, but I think it’s important to try and not be too reactive to either the successes or failures. I’m definitely learning this at the moment; we’ve gone through […]

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Don’t be too reactive. Running a medtech startup, any startup for that matter, is a bit of a rollercoaster. You’re going to encounter bumps in the road, but I think it’s important to try and not be too reactive to either the successes or failures. I’m definitely learning this at the moment; we’ve gone through significant growth in a short space of time and with that there has been the odd growing pain. I’ve learnt to accept them better, rather than to try and fix something that perhaps never needed to be fixed in the first place. Sometimes it’s best to sleep on things. Pause before sending an email or message on Slack. Give yourself time to think of the best response.

The Virtual Reality, Augmented Reality & Mixed Reality Industries are so exciting. What is coming around the corner? How will these improve our lives? What are the concerns we should keep an eye out for? Aside from entertainment, how can VR or AR help work or other parts of life?

As a part of our interview series called “Women Leading The VR, AR & Mixed Reality Industries”, we had the pleasure of interviewing Dr Nadine Hachach-Haram FRCS (Plast), BEM.

Dr Hachach-Haram is Consultant Plastic Surgeon and Head of Clinical Innovation at Guy’s and St. Thomas’ NHS Foundation Trust. In 2015, the NHS clinical entrepreneur drew on her surgical experiences and her passion for innovation and education, to create Proximie; a technology platform on a mission to save lives by sharing the world’s best clinical practice.

Dr. Nadine received the British Empire Medal in the 2018 Queen’s Birthday Honors for her innovative work within the fields of surgery and medicine. She also undertakes a number of roles to help advance surgery, including council member of the Royal College of Surgeons Future of Surgery Commission, council member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), Innovation UK and council member of the Royal Society of Medicine plastic surgery section.

Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and how you grew up?

I grew up in post-war Lebanon in the early 1990s which was undoubtedly a formative period in my life. It shaped my career, not just as a surgeon but also as the founder of Proximie. Seeing the human impact conflict exacted on my homeland had a profound influence at a very young age. At that point I started to get interested in the ability to help patients and to look for opportunities. Soon afterwards, when I was 14, a family friend who was a plastic surgeon was going down to Sidon to do some reconstruction for some young trauma patients. He was probably a bit surprised I wanted to go with him! But he was willing to take me which was great, I owe him everything for that. After that, any time I could get into an operating room I wanted to see what was going on. Even now, I still love it. It’s very humbling, you are in an operating room, the patient is asleep, you have a team around you trying to make a positive difference in a patient’s life.

Is there a particular book, film, or podcast that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

I read Nineteen Eighty-Four by George Orwell as a child and it sticks with me to this day. The dystopian future he imagined is obviously rather prescient for many reasons, but ultimately it highlights the values of honesty and clarity of communication.

From a business perspective, Crossing the Chasm by Geoffrey A. Moore resonated with me as a CEO of a tech business. The chasm refers to the technology adoption lifecycle, and looks at how disruptive businesses have transitioned from little-known and exploratory products, to mass adoption. It feels even more timely to me given where Proximie is in its development.

Is there a particular story that inspired you to pursue a career in the X Reality industry? We’d love to hear it.

I spent 10 years working on global health initiatives around the world. During that period I definitely found myself feeling like I simply wasn’t doing enough. You start to look back and see what impact you’ve had and how much you’ve actually been able to scale expertise or support independent delivery of care locally. When I looked at the Lancet Commission that revealed five billion people in the world lack access to safe surgery, I realised that we were only scratching the surface. That it was really about building scalable, sustainable models of support and delivery, so I started to look at technology and the idea for Proximie was born.

My Dad is a computer engineer and I was a gamer as a kid. I liked to put computers together with him! In telehealth there was not really that multi-sensory experience. As a surgeon, I needed to be able to point out and demonstrate and give audible and visual instructions. People had begun to speak about the possibility of augmented surgeries, and Pokemon Go had come out. That definitely shaped our thinking as well.

I founded Proximie based on the ethos that shared knowledge leads to accelerated learning and better patient care. Proximie was built to allow experts to virtually scrub-in to operating rooms and cath labs around the world, to support, coach and mentor each other, and to really look at the continuum of expertise throughout a surgeon’s career. I had been exposed to early-stage telecommunications platforms, but all of them are anchored to one moment in time. One meeting, one call, one conference, but then it’s gone. The options available did not enable a continuum of sharing knowledge and expertise, and they were too passive. You can’t do remote surgery in 2D. It has to be more immersive than that. What we wanted to do with Proxmie was to create a multi-sensory experience that was a catalyst for collaboration and could digitize a surgeon’s footprint.

We wanted to extend the geographical reach of a surgeon and create the effect of a borderless operating room that could empower physicians to remotely share knowledge that could ultimately reduce variation in care, and help save lives.

Can you share the most interesting story that happened to you since you began this fascinating career?

There are so many! I think that is the beauty of our platform. Every case is a story in itself and whilst I can’t profess to be central to every single one, I feel immense pride and a connection to the stories Proximie are helping to tell every single day. At the moment, we’re assisting 900 procedures a month; behind every one is a story. It could be about the technology, the interesting location perhaps, or the innovative way Proximie was harnessed to assist the procedure. But ultimately at the centre of every single one are real people. Real physicians, real patients and real emotions. From the surgeon in Eastbourne remotely proctoring a surgery in Benin, to interventional cardiologists collaborating in real-time from 3,733 miles apart (from Washington to London) to help save a patient’s life, Proximie is all about connections. There is a wonderful quote from one of Proximie’s early adopters, Dr Miriam Redleaf, who is a Professor of Otology/Neurology at the University of Illinois Department of Otolaryngology-Head and Neck Surgery, who said, “The main role of this technology is to bring people closer together emotionally.” That really resonated for me. I love that quote. Behind all of the layers of technology, behind every Proximie-assisted procedure, are people.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

I’m not sure it’s funny necessarily, but early on in the Proximie journey we encountered an awful lot of skepticism. I used to take it very personally and actually used to get rather upset about it! I couldn’t seem to convince the naysayers that the idea for Proximie was not only valid, but desperately needed. At the time, I had young children and was still in surgical training, neither of which afforded me a great deal of time! Or sleep! I was impatient, rather defensive and at times possibly a little overly so. It makes me laugh looking back now. I was very young and rather green, and yet I was very confidently telling the world without blinking that we were going to change the paradigm of surgery.

There was also some (maybe reasonable) concern about whether or not we could build something that was intuitive yet capable of supporting the type of precision that is required in an operating room. Would Proximie end up being too otherworldly or cumbersome from an integration perspective? We knew we had to build something for the here and now, as well as for the future. It had to answer an urgent need and have the potential to both decrease costs and increase the efficiency and quality of care. That was the dichotomy we had to overcome and it was not without its challenges, or indeed sceptics. I was also told that this problem was too big for a practicing surgeon and first time CEO to solve. Now Proximie is in advanced discussions to help solve the global connectivity problems in healthcare using 5G and Space Technology. Disruption in healthcare has many challenges and anyone who says it’s easy or straightforward, has probably never experienced it. But if it’s really solving a problem, then adoption can be swift and decisive.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

There are too many people to individually name, but given that it is Women’s History Month I wanted to tell a story about a woman in my life that had such a huge impact on me, and who shaped the woman I am today. Despite everywhere I have lived and been, the ten years I spent in Lebanon as a teenager will always be the most influential of my life. Certainly the hardest, but it shaped me more as a person, than anywhere else. We lived in Beirut with my Mum and her mother, my grandmother. We were raised by two very matriarchal, strong, independent women. My grandmother, Leila Sayegh, was well-educated and ran a number of charities, she was very involved in helping families, doing different things to help women learn new skills. She would involve us from an early age; it didn’t just build resilience and independence, but entrepreneurialism too. She always taught me about right and wrong and was very objective in her views. She really embodied all of the things that I would eventually want for myself, and for my daughters: being fair and independent, loving and strong. I am one of four girls. She showed each of us that women can achieve anything they want. My grandmother meant everything to me; I still wear her necklace everyday for good luck. She gave me that hunger and desire and that capacity to think bigger. That mindset was born in Lebanon. To this day and forever more, my grandmother remains such an inspiration to me.

Are you working on any exciting new projects now? How do you think that will help people?

Always! In this space, we know we can’t be static and we’re always looking at new and innovative ways to better serve our surgical community. One area of perpetual focus is connectivity, which is a central theme to everything we do at Proximie. If you can solve the global connectivity issue, we know we can redress the inequities in healthcare that exist all over the world. We know that today people die unnecessarily without access to simple surgery; in both developing and developed nations. By solving the issues that can compromise a surgery in any area of the world, such as not being able to access the right clinical skills or the right equipment, we can help to ensure that the 300 million plus surgeries that happen each year, can be delivered in a consistent way, and in a way that helps to save lives. Collectively, we must increase our capacity to deliver better care, quicker and further than ever before. I believe we are just starting to scratch the surface of what is achievable. We have held interesting discussions with major players from other sectors, including those in telecommunications and Space Technology, to better understand how they are innovating and accelerating the connectivity conversation. In healthcare too often things are siloed; good ideas, as much as surgical expertise. One of our major aspirations as a business is to bring in the best thinking from other industries, to support us on our mission. There is no question that 5G is going to play a huge role in creating better connected healthcare systems. If fostered correctly it will ensure the best technologies and innovations are made more freely accessible to patients all over the world. 5G connectivity will also be harnessed to manage and monitor the petabytes of patient data, and used to continually improve patient outcomes. This will move us towards a more preventative model of healthcare. Making even low latency a thing of the past.

In addition to 5G, we’re also thinking a little further afield. Bringing space technology into healthcare is not a new phenomenon; from infant formulas to robotic surgery, space research has played a formative role in a number of healthcare innovations since the 1980s. It’s now helping to shape the global connectivity conversation. Low orbiting satellites, for example, are going to ensure that even the most remote location on the planet is suddenly back on the grid. We believe Proximie is perfectly positioned to harness the powers of connectivity technologies, and channel them directly into operating rooms all over the world. To empower physicians with real-time insights and data, and enable them to create better patient experiences. The ingredients for better connected healthcare systems are right in front of us. It’s incumbent on us, as one of the players in this field, to try and accelerate these conversations and to play a proactive role in finding innovative ways to democratise access to safe surgery, reduce variation in care and, ultimately, save lives.

Ok super. Thank you for all that. Let’s now shift to the main focus of our interview. The VR, AR and MR industries seem so exciting right now. What are the 3 things in particular that most excite you about the industry? Can you explain or give an example?

Hopefully I’ve covered some of this in the question above, but I’d like to think Proximie is at the epicentre of some of these very exciting developments. From my perspective, as a surgeon seeing how these immersive technologies are being harnessed in order to provide better care is incredibly exciting.

Surgery is adapting and evolving before our eyes, and Proximie is playing a central role in its evolution. We wrote the commission on The Future of Surgery a couple of years ago, which looked at what it is going to look like in the next 5–10–15 years, and we’re already seeing how it is becoming more connected, more data-driven, and increasingly amplified through different technologies and mechanisms that exist. The patient surgeon interface is changing so quickly and as we layer on AI into different applications, having access to real-time insights will improve patient care.

COVID-19 has been a catalyst for the rapid adoption of telehealth technologies across the board and Proximie is no different. What’s exciting about the mixed reality technology boom is that their use is being hardwired into clinical pathways all over the world, and that is only going to benefit the patient. It’s certainly not going to dissipate once the world has successfully battled COVID, if anything their use will become more habitual as we layer on new technologies. A recent paper published by Dr Albert Hajj in The Journal of Urology, concluded that Proximie “allowed more flexibility in patient scheduling and reduced travel costs with similar outcomes,” compared to face-to-face, and I think what we’re increasingly seeing is tools like Proximie being used to enable surgeons to stay connected and collaborate from any distance. This has obviously been critical during the pandemic.

By combining the best human expertise with the power of Artificial Intelligence (AI), Augmented Reality (AR), and Machine Learning (ML) we have created a borderless operating room, where every operation in every hospital can be recorded, analysed, and predicted for future use. It’s incredibly exciting to think of the future global network of operating rooms interconnected by the world’s best clinicians, where every incision is already informed by machine learning and every clinician will be empowered with real-time diagnostics, data and analysis.

We’re really moving towards a more predictive and preemptive model of healthcare and these immersive technologies are going to play an important role in that behavioural shift.

What are the 3 things that concern you about the VR, AR and MR industries? Can you explain? What can be done to address those concerns?

I think a lot of new technologies can be overhyped and fall into that ‘tech for tech’s sake’ category. I think we need to ensure that any of these new technologies have a clearly defined role and purpose. We have moved past the novelty phase of these technologies, so now is the time for any existing or new entrants to the market to show genuine, real-world usefulness.

The pace of innovation tends to be quicker in software than hardware. Its important to remember that a software first approach means that we can continue to innovate and adapt quickly to the needs of our customers delivering value on a continual basis.

This doesn’t preclude us from integrating into existing hardware in the operating room, this is no mean feat to be able to integrate with older pieces in some parts of the world and the latest machines like robots in others.

It’s one thing to have a great piece of technology, it’s another thing to have the necessary skills to implement and integrate them into complex healthcare settings, which can be incredibly varied all over the world. Proximie was born out of a need, and my ambition as a surgeon was to find a solution and scale it using technology. I wanted to try and create a solution that could empower surgeons to collaborate in real-time, in a very visual and engaging way. We walk a lot about ‘by surgeons, for surgeons’, and so we designed the platform to be used in austere environments, which is why we are currently used in developing nations and by the UK military, connecting field hospitals with NHS surgeons, to provide better care for front line military personnel. Accessibility, affordability, working at low bandwidth with existing or easy to resource hardware, all of these elements were factored in with the end environment in mind, which is crucial. Proximie can secure approval for use in a new hospital within three weeks because we know and understand the environment. I’m not sure that is the case with every mover and shaker in the VR, AR and MR space. I think having our mission and purpose at our core has been integral to our subsequent growth.

Finally, I think many new startups within the VR, AR and MR spaces that might have previously been struggling pre-COVID are having their moment due to everyone being confined to their homes. I think the real-proof of their staying power will come post the pandemic. Are these exciting new innovations here to stay or will people turn away from them when lockdown measures cease? The proof is in the puddy!

I think the entertainment aspects of VR, AR and MR are apparent. Can you share with our readers how these industries can help us at work?

I think the gamification of education is really interesting, specifically in the clinical space but in other sectors too. Whilst educational programmes and training have inevitably been disrupted due to the pandemic, we have seen the resilience, adaptability and innovative spirit of the surgical community shine through during these turbulent times. To negotiate the lack of access to both operating rooms and travel, we have been pioneering a host of new educational programmes during the pandemic to support surgical trainees at a time when their education has seriously suffered. One fantastic example of this innovative spirit was from The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), who enabled anatomically realistic porcine tissue models to be shipped directly to the homes of surgeons, where they could continue their procedural education at home using the Proximie platform. A key benefit of technologies like Augmented Reality as a learning tool is that it can create a highly engaging, immersive educational experience, which can empower trainees to grasp complex techniques and procedures from the comfort of their own. I think we have certainly borrowed that mindset from the gaming industry to find new ways to keep people engaged. COVID-19 is having a profound impact on the way surgical skills are taught and applied, now and in the future.

Are there other ways that VR, AR and MR can improve our lives? Can you explain?

I think there are a number of ways these technologies can have a positive impact. The use of Proximie, for example, is not just helping to democratise access to care but it’s saving on global travel and therefore helping to reduce carbon emissions. I think during COVID-19, we have seen how remote technologies can drive business efficiencies during these work from home age. Fundamentally, a lot of these technologies when executed correctly should make us more effective, time efficient and a lot more productive. They should help us save time, manage resources better, and enable us to work quicker and smarter. The potential is limitless.

Let’s zoom out a bit and talk in broader terms. Are you currently satisfied with the status quo regarding women in STEM? If not, what specific changes do you think are needed to change the status quo?

It’s more about inclusivity for me. We all need help, mentors and support throughout our career and also role models that we can aspire to follow.

It’s important as women we support each other but also ensure that we support those that have a common goal and a common aspiration to your own.

I am a mother, surgeon, founder and CEO, and yes, we all have unconscious biases that affect our outlooks and at times actions. I want us to focus on a collective, collaborative approach to challenge the norm, to strive for improvements, to trailblaze and to inspire. All with the aim of leaving the world in a better place.

What are the “myths” that you would like to dispel about working in your industry? Can you explain what you mean?

Look, I really think progress is being made and progress has been made. If you were to look back at women working in STEM 10, 15, 20 years ago that landscape is totally different from today’s and I think that should be acknowledged. We need to reinforce the benefits of a career in STEM at a young age; I have a 14-year-old daughter who I’m constantly trying to inspire, encourage and excite her about some of the work she is doing in school, particularly in sciences and mathematics where I feel sometimes there is a lack of excitement for girls her age! My father was a computer engineer and I was a bit of a gamer as a child. I think both certainly helped me feel more engaged with the technical side of things. I also think we need to really break this idea that women are not ‘as technical’ as their male counterparts. Having worked in plenty of operating rooms all around the world, I think that is incorrect and something that needs to be debunked.

What are your “5 Leadership Lessons I Learned From My Experience as a Woman in Tech” and why? (Please share a story or example for each.)

Be human. It sounds easy enough, but when dealing with a variety of different people from different walks of life, there is immense power in remembering to do simple things; listen, empathize, and treat every single person you meet with the same level of respect. Be authentic and be yourself. There are examples everyday I could reference; from communicating with medical device organizations, internal meetings, and even being in the operating room. Being yourself can carry you a very long way, but when you’re younger you tend to have this imposter syndrome where sometimes you really don’t believe in yourself. I’d urge anyone young to not listen to the people that tell you that you can’t do something, because if you really commit to it, and you really believe in yourself, and your mission, you really can do anything.

Be courageous. Anyone who has ever endeavoured to create a disruptive business, in healthcare in particular, will know that it is hard. You will encounter knocks along the way, but have the courage of your convictions, have faith in your team, and don’t lose heart. I have been told many times that Proximie as a concept would not work and would not become a scalable business. We recently surpassed our 9,000th procedure and we’re currently assisting over 900 operations a month, on six continents.

Listen. Don’t be afraid to lean on the experiences of others. Friends, family, mentors, peers, even competitors. You can learn so much from just listening to others. I have been fortunate enough to have many people to lean on throughout my career and their advice and guidance has been instrumental.

Don’t be too reactive. Running a medtech startup, any startup for that matter, is a bit of a rollercoaster. You’re going to encounter bumps in the road, but I think it’s important to try and not be too reactive to either the successes or failures. I’m definitely learning this at the moment; we’ve gone through significant growth in a short space of time and with that there has been the odd growing pain. I’ve learnt to accept them better, rather than to try and fix something that perhaps never needed to be fixed in the first place. Sometimes it’s best to sleep on things. Pause before sending an email or message on Slack. Give yourself time to think of the best response.

Remember your purpose and your mission. What are you trying to achieve? What problem are you solving? Whatever that may be, make sure that everyone within your business is aligned to your mission.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

Every single person in the world deserves to have access to the best possible healthcare, no matter where they live in the world. It is a fundamental human right and yet we know that five billion people in the world don’t have that luxury. From the bottom of my heart, the mission we are already on with Proximie — to save lives by sharing the world’s best clinical practice and to democratize access to the best possible care — is the one I want to help realise.

We are very blessed that very prominent leaders read this column. Is there a person in the world, or in the US with whom you would like to have a private breakfast or lunch, and why? He or she might just see this if we tag them 🙂

I was incredibly moved by Amanda Gorman and her poem ‘The Hill We Climb’ at President Joe Biden’s inauguration. Her words, her poise, her courage, she is 22 years old. I get emotional just thinking about her on that stage in front of the watching world. I have three young children and she had this magnetic draw of power and vulnerability that drew everyone in. You could hear a pin drop.

“And so we lift our gazes not to what stands between us, but what stands before us.

“We close the divide because we know, to put our future first, we must first put our differences aside.”

I watch her reading at the swearing in frequently and I’m totally humbled and inspired by her. She embodied something very timely and very very important. Breakfast with her would be pretty cool!

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