Surgeon, Innovator, Researcher

Transparency is necessary to engender trust in any industry, and by forcing failures and bad practices to be publicly evident it stimulates better oversight and quality improvement. For clinical and cultural reasons, the operating room has been sequestered from public view since decline of surgical theatres in the 1960's.

A new era of surgical transparency is emerging, largely fueled by the advent of video recording for quality improvement. Despite the clear potential benefits to understanding and improving the operating room, we must carefully consider the potential effects that ubiquitous recording can have on team behavior and on patient privacy. I spoke on Transparency and Ethics in the Operating Room at the 2018 MacLean Conference.

In 2021, I hosted a conference on the Ethical, Legal and Social Implications of Surgical Recording to examine issues of surgical transparency and identify barriers to implementation of audio and video recording in the operating room for quality improvement. More details, videos of the sessions, and additional references are available at surgicalrecording.org.

My publications since 2015 also include research on overlapping surgery - a practice where one surgeon overlaps some part of two procedures. In these cases, assistants or trainees handle more routine aspects of the surgery. While this is safe and appropriate when handled correctly, it is critical that patients are informed of who will be doing which parts of their surgery while they are under anesthesia. and that trainee participation is closely managed. This topic has highlighted  a significant disconnect between patient expectations and the reality of the operating room, and we continue to study patient perceptions to understand the effect that surgical transparency will have on the surgeon-patient relationship. We also uncovered substantial overlapping surgery policy variation amongst hospitals that permit overlapping surgery and have called for reevaluation and standardization of these policies.

Ultimately, these hidden aspects of surgical logistics call for a new language of transparency where complex topics can be discussed with patients easily. As part of this effort, we have started an effort titled, "Consent Informed" to examine the language used during the surgical informed consent process and in the documents that patients are asked to sign before surgical procedures.

A visual abstract of my surgical transparency research narrative appears below.

Human-centered design is sorely needed in health care. This includes tangible, patient-level enhancements such as the devices we developed with patients during the first DesignWithPatients event, LaryHacks. This also includes systemic interventions to improve the way information is used by health care providers and patients.

I am presently heading up a redesign of the surgical informed consent process in collaboration with Cat Moon and the Program on Law and Innovation at Vanderbilt Law School; our first stakeholder event was held November 2018 in partnership with Nashville Design Week. We envision an informed consent document and process that bolsters surgeon-patient communication and serves as a record of shared decision making, while diminishing administrative burden. I will be highlighting these efforts on ConsentInformed.com.

I also have a longstanding interest in redesign of the OR and the way the surgical built environment can affect efficiency and team performance. This requires our continuing to open the doors of the operating room to experts from other fields. Here is a guide my team and I wrote on field research in the OR for those outside the medical field.

As part of Vanderbilt University's accelerated focus on innovation, commercialization and entrepreneurship, I am currently serving as an inaugural "innovation ambassador" for the Center for Technology Transfer and Commercialization. In this role, and drawing from my experience with Explorer Surgical, I hope to simplify the pathway for my clinical colleagues to translate their insights towards commercially-available products and services that can reach larger patient audiences

The key to improving team coordination in the OR ensuring that every team member has coordinated information specific to their role and specific to the moment in the case. It was this insight that lead to the creation of Explorer Surgical. It is also important to consider how technology can best be implemented in surgical environments, and I shared some lessons on adapting technology to the operating room at AMIA 2018 Clinical Informatics Conference.

While serving on the Clinical Transformation Advisory Committee of the Center for Medical Interoperability, we held an event in conjunction with the 2018 inaugural Nashville Design Week on how information technology and the surgical built environment interact.

In addition to displaying information, it is critical to consider how to capture information in the operating room. A few years ago, my lab conducted on using the Microsoft Kinect to assess ergonomics in the operating room. We found that he Kinect is a useful tool for anonymous recording of surgical activity. My present passion project is developing a wearable camera for the operating room, nicknamed "Cleopatra", that overcomes the challenges of boom- and head-mounted cameras (obstruction and instability). I obtained a grant to focus on this work as the 2020 Vanderbilt Institute for Surgery and Engineering Physician in Residence.