A Discussion with Dr. Caprice Greenberg, Part 2

Previously, AlliedHealthWorld.com spoke with Dr. Jacob Greenberg about using Google Glass in the operating room. We also spoke to Dr. Caprice Greenberg about how she became a surgeon and researcher and why collaboration between doctors is so important. In part 2 of that interview, we discuss her use of Google Glass and coaches to help come up with ways doctors can learn how to critique and help others in the field.

Surgical Technology

Ramos: OK, and, getting a little bit more into the topic you've taken time to discuss with me, how exactly did you come up with the idea for using Google Glass to record surgeries.

Dr. Greenberg: So, just to clarify on that, we're not really -- we're not using Google Glass to record surgeries yet…We're exploring a lot of different technologies to do it. When I was in my residency- I mentioned I took those two years off to do research, and part of what I did during that time was to partner with some folks from Human Factors Engineering, and Human Factors Engineering is a discipline that studies people in their workplace and tries to optimize the way that people interact with each other and with the system in which they work. And so we went into the operating room and did lots of observations of surgeries where we tried to understand the processes of care -- me bringing the clinical surgical lens and the person that I was working with bringing the human factors engineering lens -- and so we were always partnered, a surgeon with a human factors engineer. And it just really opened my eyes, again, to what we could accomplish in terms of improving patient safety and quality by working with people from these other disciplines.

But it was really, really challenging to be able to capture everything that happens in a busy operating room in real time. And this was in the early 2000s. And I think that over the last, you know, 12 years, we've really seen a shift, primarily following, I think, the Institute of Medicine reports that came out -- Crossing the Quality Chasm and To Err is Human -- where we've really moved to an era of increased transparency and increased focus on patient safety. Even at that time we recognized the value that video recording and going back and watching an operation repeatedly, where you can really figure out what's happening and the ability to sort of tie events that happened later in a case and go back and watch what happened earlier, as well as to be able to focus on maybe what one person is doing, say, you know, what the circulating nurse was doing, while looking at what the surgeons are doing would really allow us to understand what's happening from a safety and quality standpoint much better. But I think that, you know, we really had to evolve in terms of our culture to the point where people felt comfortable video recording operations. And really understanding that this isn't about remediation, it's not about performance evaluation, it's really just about trying to understand how people in a given role function and how we can design the system or help educate people or do things- ways- or find ways to improve the quality and the safety of what we do.

Ramos: And was there a system for this before or was it, sort of, doctors were just expected to be able to help themselves to get better by doing independent research and study?

Dr. Greenberg: So primarily, for people in practice once you finish residency, we really think people are competent. And we have to participate in something called continuing medical education but that really primarily involves going to meetings, reading the literature, trying to stay up on defining new ways to improve our own performance. In terms of team and system performance, prior to the early 2000s, there hasn't really been a lot of effort devoted to trying to understand how people function together. This was sort of a new thing for us to be thinking about in the operating room. And so a lot of what we're doing is research oriented to try to find ways to help people to improve.

There's a variety of different projects that we have going on that are focusing on either how can we help an individual surgeon who's in practice on their own to perform, so one of the things we're doing is trying to use videotapes to help people work with another surgeon who functions as a surgical coach to help them improve their own performance, or can we study the ways that teams interact and try to define ways that we can develop interventions, say, in a simulation setting to help people start to work better. There's a number of other things going on in health care around standardizing language or team training, like crew resource management and those other sorts of things. And I think by bringing video into the OR we can really start to study the impact that some of those interventions that we've tried to adapt form other fields might have in real time.

Ramos: OK, and I read somewhere that you were using sports coaches to help you look at some of the tape and provide insights. Is that correct?

Dr. Greenberg: Yeah, so what we did was we actually went and talked to coaches in other fields. So we talked to people in our athletics department, some of the Badgers coaches, we talked to people in the school of education, we talked to somebody who ran a program for teacher coaches within one of the local school districts. We talked with people who served as coaches within music, so accomplished musicians who worked with expert musicians to try to continue to improve their performance. And our goal was really to understand how people in these other fields use coaching to continue to improve throughout their career, no matter what level they were at. I think one of the things in surgery is that, you know, people are very confident in what they do and we have people who are experts and do things in a fabulous way, but what we're trying to suggest is that maybe there can be room for incremental improvement no matter what level you're at. And then we also try to learn from those people what were the characteristics of an effective coach, and so, trying to figure out, well, we know that we want our surgical coaches to be surgeons, because they have to understand what's happening during an operation, but how do we then go about figuring out who among surgeons would be the best surgical coaches to identify.

Ramos: And what are some of the insights that these different coaches have brought to you where you said, oh, wow, I never would've even thought to utilize that when talking to other doctors and surgeons?

Dr. Greenberg: Yeah, so, you know, I'd rather probably not get into too many specifics about this just because I have a paper that's under review right now. If you don't mind…

Ramos: Oh no no no no, that's perfectly fine, it'd be kind of rude to say "no, that's not OK."

Dr. Greenberg: [laughs]

Ramos: [laughs] But, well, I had- like, one other thing about that, I don't know if maybe you'd be OK with getting into this, but, you know, was it difficult for you and some of the other doctors to accept this coaching at first or was it something that you really wanted and needed and so you guys were gung-ho about it from the beginning.

Dr. Greenberg: So, there is a ton of interest in the idea of surgical coaching within surgery, but it's incredibly early in the process, so, you know, our program is really just getting off the ground, which is the reason that I can't talk to you much about it, but I would say most surgeons are pretty open and excited about the idea. Like anything, any time you're trying to change something, there will always be people that don't necessarily think it's going to work. I would say overall there's a lot of enthusiasm but it remains to be seen whether or not it's going to be effective. I think some of the basic principles that we're working from certainly speak to most people.

Ramos: OK, and are there any technologies out there that you're seeing that you think that could be beneficial in health care that weren't necessarily created just for health care?

Dr. Greenberg: Yeah, so what- as I mentioned, you know, what we are doing is experimenting with or exploring the use of a variety of different approaches to capturing what's happening in the operating room, so, you know, we are exploring Google Glass, and there's been a number of articles I've read recently about other people in health care who have used Google Glass effectively, so I know that there's an emergency department in Boston that has used it, there are some orthopedic folks that have been using it, and so we're very interested in trying to figure out how to use it. There are some limitations with the technology and some issues around sort of HIPAA compliance and patient privacy that we- that need to be worked out.

The other technology is sports goggles, so there's goggles that have been created for extreme sports which have a camera and a microphone in them, which we are exploring, and then GoPro cameras, which similarly were created for extreme sports. The other thing is that, you know, a lot of operating rooms are already equipped with in-light cameras. It's quite easy to capture images from a laparoscopic procedure. Some ORs even have room cameras, and so a lot of the technology already exists within our operating rooms and it's just a matter of figuring out how to use them, figuring out how to make sure that patient privacy is protected and that the staff that works in the OR is protected, but that we can, you know, start to use this technology that exists to improve what we do.

Ramos: OK, and I have one last question. Is there anything I may have missed today or anything that you feel is important for our audience to know about you or your work?

Dr. Greenberg: I guess the thing that I would just say is that there are a variety of different career paths that people take within medicine or surgery. You know, there are people that are pure clinicians, there are people that are clinician educators, like Jake, who you talked to, and hopefully he talked a little bit about his master's in education degree and what he does in terms of education for our residents. And then there are people like me who spend a lot of our time doing research, and there are certainly people who are physicians who are still active in health care and who don't necessarily take care of patients but have value in other ways, whether it be through getting administrative positions, I think having having people who have clinical experience and are trained physicians who are part of hospital administration is really critical. And, again, being a physician is just incredibly helpful especially when you're researching things like processes of care and safety and quality to really have that intimate knowledge of how patients and professionals interact in the health care system. It just gives you a different level of insight in terms of being able to do that type of research.

Ramos: OK, well once again I want to thank you for taking time today and I really do appreciate your candor and, you know, the answers to all these questions.

Dr. Greenberg: Sure, my pleasure.

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