Beauty in Healthcare. Meet Dr Raj Aggarwal, Chief Growth and Strategy Officer at Panda Health | RadicalFutures

In this segment, Dr. Rajesh Aggarwal, current Chief Growth and Strategy Officer at Panda Health, and former Director of the Steinberg Center for Simulation and Interactive Learning at McGill University’s Faculty of Medicine, sits down with us to discuss the seemingly disparate relation between beauty, synchronicity and innovation in healthcare. A gastroenterological surgeon by training, Dr. Rajesh Aggarwal now leads multiples ventures in the digital health, healthcare innovation, and education sectors. 

Dr. Rajesh Aggarwal recalls how a singular experience at the ballet led to a newfound appreciation for the instrumentality and force of beauty and synchronicity. He began questioning what a “well-choreographed system” looks like in the context of clinical care delivery and healthcare systems. How can the concept of beauty, of choreography, synchronicity translate to a beautiful, harmonious experience in medicine and healthcare? 

Dr. Rajesh Aggarwal also questions the tie between beauty and innovation – how can innovation embody or translate beauty and synchronicity? Drawing on conceptual examples, notably that of Brownian Motion, Dr. Aggarwal encourages us to think of systems-interactions as cumulations of “creative and unintended collisions.” Out of the seeming randomness of systems, we may find the space for creative and innovative interventions. 

 

Interview conducted by Salome Henry

 

Episode Transcript:

Introduction: This is not a race against the machines. This is a race with the machines. From quantum physics to poetry, from neuroscience to geography, from philosophy to immersive realities, Building 21 is a space where one can explore, play with, manipulate, bend, break, and probe the multifaceted dimensions of ideas, knowledge, and thinking.

Doctor Raj Agaval is a surgeon, specializing in laparoscopic surgery. He received his PhD from Imperial College London, with a thesis on virtual reality and hand motion analysis in laparoscopic surgery. He is currently the chief growth and strategy officer at Panda Health. Before joining Panda Health he held the position of Vice President of Strategic Partnership at Thomas Jefferson University. From 2014 to 2017 he was the director of the Steinberg Centre for Simulation and Interactive Learning at McGill University. 

Salome: Hi, Doctor Agaval, thank you for sitting down with me. It is lovely having you here today on our Building 21 podcast. I would love for you to give a little bit of an introduction of yourself to everyone who is listening today. 

Dr. Agaval: Great, thanks, Salome and thanks for the opportunity to talk to you all about the great work that you're doing at Building 21 at McGill. So probably the most important place in terms of introducing myself: I spent three years at McGill as a faculty member as an associate professor and a GI surgeon. That was from 2014 to 2017. And I was also director of the Steinberg Centre for Simulation and Interactive Learning at that same time. And so really, you know, fulfilled the role of a clinician, a scientist, an educator and also an innovator. In terms of my general background, I'm born and brought up in the UK, always wanted to be a doctor from the age of four years old. It's one of my earliest memories of wanting to be a doctor. And really went through all the parts of medical school and residency training, and really started my scientific career more formally when, during my surgery residency, I did a PhD in virtual reality and robotic technologies and how they applied to healthcare. And then completed all my training and moved to the US almost a decade ago, spent a few years at the University of Pennsylvania doing clinical practice and science, and again working kind of cross disciplines, so working with the Faculty of Engineering around robotic platforms, working with the Faculty of Education around digital platforms for education. And then as I said, spent three wonderful years at McGill and again worked very much cross faculty, whilst my focus was around kind of simulation education. It really was broader than that, around healthcare innovation, and we did a bunch of really interesting topics where we worked with the Faculty of Engineering, the Faculty of Management, the Faculty of Education. Saying how do we put our collective goals together to drive forward healthcare from McGill perspective. And then, interestingly, we were outside of McGill but within Montreal with Les Grands Ballets Canadiens. We did some interesting approaches around beauty and healthcare there, and through that process is when I met Dr. Dyens. And then after McGill I've spent the last three years in an innovation and ventures role at a large health system in Philadelphia called Jefferson Health System. So really how do we partner and invest in early stage companies, and with that – it almost seems natural now, but it wasn't a few years ago – now I'm fully in the commercial space where I am the Chief Growth and Strategy Officer of a early stage company. And that's looking to improve how health systems and digital health companies work together. So that's a little bit about my background. 

Salome: Wonderful, thank you so much for that introduction. It sounds like a fascinating professional path. And I think from the people at Building 21, and some people will have listened to your previous lecture, but you spoke so eloquently and beautifully about the importance of beauty, the importance of beauty in medicine and listening to you speak of your experience at the ballet, I just wanted to ask you: where do you see this place of beauty? I mean, how did you become so interested in it? Was it a question of being interested in notions of synchronicity, questions of balance and equilibrium and the work that you were doing as a doctor, or how did you become so interested with the concept of beauty itself?

Dr. Agaval: Yeah, it's, it's an interesting question, because it almost happened without me knowing about it, right, is what I would say. And look, I've always been very much a perfectionist, and everything I've done when I was, you know, in middle school, high school, I enjoyed doing things right and got pleasure out of it. Even when I was mowing the lawn at my parents’ house in the English countryside, I enjoyed having finished mowing the lawn and you can see the perfect stripes on the lawn, right. So I very much – just, that's just me, that's who I am about that, kind of, it's got to look right. And that relates to something that when I was training in surgery, one of my mentors (this is back in London) used to say at the end of every operation. We do a complex cancer, a section operation of the stomach. And he’d say “Raj, if it looks nice, then it probably is right,” right, and that kind of goes back to those stripes on the lawn, right. And the kind of serendipity was that I had that as a construct and that's how I'd kind of done everything in my professional life to then. And it was – gosh, probably 12 years ago now, where I watched my first ballet performance at the Royal Opera House in London, and that was really where I saw what I would describe as technical excellence, and being delivered as beauty. So up to then it was all very kind of physics, maths, and it was kind of lines and straight and whatever, and that was the moment, I would say, where I was watching these ballet dancers. And I could name, you know, which muscles they were using when I could see them and I could see the strength there and I could see that – the anatomy, quite frankly. But it wasn't about the anatomy, it was about how do these individuals, and then this group of individuals, come together to create something where I can just sit back and say, “oh my god, that's beautiful.” And that is probably the moment where I started thinking about what I would call choreography in health. So whether that's choreography in my operating room or that's choreography of a health system or – I mean that either in a health system such as at McGill or a health system such as the National Health Service in the UK, right, or a global health system, right. And at the end of the day, if I now try to put this, put those two worlds together of that kind of those lines on the on the lawn, right, that kind of physics/maths approach and this kind of beauty approach, right. It really is about how do you bring people and technology together in a process to achieve a desired output. And going back to the ballet, that desired output was beauty, right. And the process is choreography, right. And the inputs that people and the technology is just, you know, these ballet dancers, they're on stage and, you know, even down to the lighting and the sound that make it look really so engaging, right, that you remember it, you dream about it, quite frankly. And so putting that together to, you know, for the here and now, even in my role at this company, Panda Health, of how do health systems procure digital health technologies, just in the way we run our lives in every other way. Like, I haven't been to a bank for many years, I haven't been to a travel agent for many years. I still go to the supermarket though, that's probably going to change, but everything is done digital, you know, generally on our phones or on our laptops. And how do we transform healthcare in that kind of digital experience, right. And again, it's about choreography, to create. And it's challenging to think about it, a beautiful experience. Like, how can you say that, you know, someone learning that they have stage two breast cancer, and they're going to need to have surgery and chemotherapy can be a beautiful experience? Well, what I would say on that is that it needs to be a choreographed experience, right. And the perspective of the patient and their family and not to be what I politely call a clunky experience, because that is what, unfortunately, healthcare is about, and to be less polite, it's about the resilience of individuals – that includes patients and their families – to manage those dropped balls, right. And so that is really how I'm thinking about my role right now. It really is choreography around different facets of our lives, of which healthcare is one of the most important facets. 

Salome: Right, of course. And then what does a well-choreographed healthcare system experience, let's say, look like? How can you, you know, have a hand on these different elements? I mean, there's, you know, there's innovation, that can be innovation in different sectors. But how can you bring together harmoniously a single experience that can be considered beautiful? I know that at least for my experience, I, you know, I can see a patient – I used to work in South Africa. I did work on user patient user preferences, you know, interactions with medical staff. And that is often a very beautiful experience, seeing a patient interact with a provider, seeing the trust, you know, there's an entire relationship that forms. And you can consider that to be a beautiful, beautiful act. I mean, one could even say that the medicine in itself is a form of beauty, it's a form of extension. It's providing something of grace. But to come back to my question, how do you think that – how can we really have a harmonious system that is well-choreographed in the healthcare space? 

Dr. Agaval: There's a number of layers to your question. What I would say is, traditionally, and it's not just healthcare, but it's, it's many, many entities of society, whether it's healthcare, whether it's education, whether it's the prison, it's all about control. Right. And so in order to be able to control – and this isn't about controlling people, it's about controlling the system. Right. There’s standardization, right. So why does the old fashioned hospital ward actually look not dissimilar to a prison, right? You know, you have all of the rooms there, and you have one person who can literally look at everything that's happening and not dissimilar to a classroom or a set of classrooms. It's how society was grown up, and how does a factory look the same? It's about standardization, right. And we now know that – well, we probably knew at then, but we didn't pay much lip service to it, but you know, healthcare is a very personal experience. And when you engage as an individual, then the outcomes can be better. The challenge there is that you do need to have some degree of standardization, right, because you can't just have everyone saying, well, you know, this is how I want to run my healthcare. And this is how I want to run it and whatever, right, or education, right. Then, there would just be a completely an anachronistic state, right. If they've always just allowed to do whatever they wanted. So there's how do you go from standardization to personalization There’s a phrase I really like and it's called mass personalization. So how do you create enough structures where you can get what you want out of the healthcare system, or you can get what you want out of the education system, right, which might be slightly different from what someone else wants. But it still feeds into those structures. And then there's another layer to this, Salome, that I'd say, which is around innovation. And you mentioned that. And my kind of concept for innovation – there's two, I would say, and one is very topical right now. One concept is this concept of Brownian motion. I don't know if you've learned about Brownian motion when you're in school, right. When you look at molecules under a microscope, they're going zim zim zim zim zim zim. And it's what I call this concept of unintended collisions that occur, right. Right. And I would say even to personalize this, you know, me meeting, Dr. Dyens was an unintended collision. Why, why would a poet, right, meet a surgeon, right? And why would they do work together, right? That just doesn't make much sense in the way we structure our education systems right now, but we did connect. Right. So there's unintended collisions. And they can be positive or negative, right. They can work or not work. So that's one approach, which is very opportunistic, or it's a wholly hoped opportunist, right. Okay. And then there's another approach that I think is a really ripe model for innovation, not just in healthcare, but I'm going to use the model of how viruses actually evolve, right. And I don't know if you know about this. I've been thinking about this for probably over a decade, but it's quite topical now. So when a virus evolves, it does that in two ways. It can have incremental evolution. So, you know, a few of its gene pairs modify in the mRNA. Right. So this kind of – that's called anti-genic drift, right. Okay. Or there can be a completely new set of genes come into that, which don't normally come from another species, right, hich is what we've seen with avian flu and swine flu and so forth. And that's called anti-genic shift. So there's a step change. All viruses are generally kind of evolving, right. And if we say that that evolution is positive, they're generally kind of on a gradual improvement. And then suddenly there's a step change, right. And then that leads to a pandemic. Because there's no herd immunity, right. We all know this now. Society knows this. It was just scientists that knew this previously. And that's kind of my approach for thinking through innovation and my lens of healthcare innovation, where there is gradual, kind of incremental change happening, just because we as human beings, and in terms of our structures and processes, things are generally getting better. But then there might be what I would call a copernican revolution where suddenly something changes, right. So we can call it the fourth industrial revolution, right, the digital health revolution. Or we can call it, you know, 150 years ago the agricultural revolution. And so, bringing it back to kind of healthcare, right, which is what I know. Healthcare has had dramatic changes, which I would say, you know, almost 100 years ago was the evolution of anesthesia, right. That was the evolution of antibiotics, right. The evolution of transplants, right. And now we're down to stem cell transplants, right. And then more recently, the evolution of which I was involved in 20 years ago, where we started calling it image guided surgery, right. Where you'd actually do surgery using devices, right, rather than instruments, right. And now where we're at is thinking about this, yeah, this digital revolution, whether that's internet of things, whether that's AI and machine learning. And down to whether that's the smartphone in your pocket and how that can be a part of pervasive healthcare as well. So, it's a very long winded answer to your, to your great question. But there's lots of layers, from the standardized piece, to the personalized piece, the mass personalization piece, to then this kind of unintended collisions piece. And then this kind of, you know, what I call antigenic shift and drift piece. And how do you put all that together as an innovator, as a healthcare provider, as an individual patient, and then for society. And quite frankly, I think you need all of the above. 

Salome: Wonderful. As a bit of a separate question, but I think this is also an important one, for the future of the medical curriculum, how do you think teachers and students can incorporate the idea of beauty, can it ameliorate, yeah, I mean patient provider interactions? Do you think it can have better outcomes on better health outcomes? Is it an essential part of the future of medical education? Can students think of beauty as a product of their work, as a desired outcome, or maybe as a part of the experience, maybe of becoming a physician?

Dr. Agaval: Yeah, it is, Salome, a related question. Look, from an education perspective, you've got to have, you got to have your base by saying, OK, or, you know, how do you want to learn about medicine and it's kind of a free fall that's, that's not going to work. You've got to have your base of whether it's biology, psychology, you know, maths, and those kind of things, right. Over and above that where I would take your answer to is when we talk about, and I've already talked about it, this kind of choreographic approach, right, and we think very much about the output of that in terms of the care that's delivered to the patient and to their family, right. And we don't spend enough time thinking about how that choreography actually gives satisfaction, is probably the simplest way to put it, but it doesn't feel strong enough – satisfaction or engagement, satisfaction and engagement for the provider, right. So I'm working in an environment that works, I mean, just think about the last time you tried to use a device, a tool, a bicycle or something, and it didn't work, right. How frustrated did you get, right? And you wanted to get from A to B on the bicycle, but it just didn't work, you kept falling off, or the wheel was loose, all that kind of stuff, and it gets you frustrated, gets you angry, and you might give up. And we think about this kind of choreography and delivering beauty for the end user for that mass personalization that I talked about. We shouldn't forget about the actual stakeholders that are delivering that care, and I'll take it back to the ballet dancers. I've seen a ton of ballet, right. I used to be on the board of Les Grands Ballets Canadiens, I was on the board of the Pennsylvania Ballet, and you know, in pre-COVID days when I used to travel to San Francisco or Boston, whatever, I'd always check the ballet schedule, and you know, I'd finish up my business meeting and then try and catch a ballet. And I'm more engaged in watching a ballet performance when I can see that the dancers are more engaged, whether that's through their eyes or whether that's just through their passion, right. And I've watched so much and many of my friends, now ballet dancers, they say, when your heart's not in it, you can't dance well, and the audience knows. And so that, in back to health, get that delivery of care experience, right. For us to engage our stakeholders in getting back to the students, right. So how they learn, they need to engage in that, right. So we need to not just pay lip service, say, hey, this is a choreographic approach, but just say, just as a ballet dancer needs to be engaged to deliver a great performance, we need to engage our students, our residents, our faculty to be able to deliver the care that is that kind of beautiful care to our patients. And so that's quite frankly a concept. How do we create that into a construct and operationalize that? I don't know the exact answer to that. That's a whole other conversation for how do you kind of take that concept and make it real. 

Salome: Right. I wanted to follow up on this idea and you spoke about this previously in our last lecture, the idea of removing control, removing regulation and creating a space where there can be innovation, there can be creativity. Do you think that COVID has pushed for this kind of thinking a little bit more? Do you think people are more interested in taking risks? And being alright, I suppose, in the innovation and the healthcare space of trying new things, maybe starting, not starting from scratch totally, but doing something without necessarily a safety net. Or is it maybe not the right time to be doing that? I know that people have been saying the healthcare system wasn't prepared adequately for COVID. The innovation hadn't followed up and now we’re suffering the consequences because we weren't prepared. But can this be a nice, an important awakening in the healthcare industry to push for more innovation and to push for notions of – not a free fall, a controlled free fall in your opinion. 

Dr. Agaval: So I do have an opinion on this and I would say the kind of Silicon Valley approach of move fast and break things doesn't work in healthcare. There's an article in Forbes actually published just yesterday, which said if you move fast and break things in health care, then the risk is that people die. What I would say to your question is actually – this may surprise you – it's less about innovation from a technology perspective, right. And I would say what we need more of is innovation and loss of control and – your word – free fall from a cultural perspective, from a cultural and a hierarchical perspective. A lot of the technologies, even with COVID in the last 12 months when you talk about telemedicinal virtual care, that's not new. You and I've been probably using FaceTime for over a decade. That's all it is. The upswing happened because there was acceptance of doctors and health systems that if they didn't do this, well, it wasn't acceptance, it was forced acceptance; if they didn't do this, they wouldn't see any patients. Number one, and number two, there's acceptance of policy that they needed to regulate for this, rather than against it. And number three, which is the most powerful thing, is it gave patients choice. It wasn't on the health system or the doctor's terms now, it became on the patient's terms. Now I remember after the pandemic or during the pandemic, but after it was the worst part of it, I was back in my clinical office in September last year. Now I remember overhearing one of my administrators on the phone to one of my patients and asking my patient what time they would like to see Doctor Agawar next week in the clinic. And then saying, okay, nine o'clock next Tuesday, would you like to come in or would you like to have a telehealth visit? That would never have happened pre-COVID. It would be nine o'clock next Tuesday, you'll be here. No option. And so I think that's where we need more of, in terms of – you call it innovation, I call it cultural innovation, or kind of breaking those hierarchical aspects, where patients need to say, I don't run any other part of my life like this. I don't go to the travel agent. I don't have to go to the cinema to book a ticket and then come back to actually watch the film. So why do I need to come into the doctor's office when all you've got to do is just talk to me? There might be some times when it's appropriate. And so that's where I think the driver needs to be in order to, you know, we can't lose control in healthcare, but we need to enhance the ownership. Control’s probably a good word, of the end users, the patients, but also as I mentioned earlier around this kind of choreographed beautiful approach with the analogy of the bicycle, but also enable the providers not to just feel like they’re factory workers. I have to do this because I'm told. Well, maybe you don't, okay. If you want to come in and not do your clinic on, you know, Monday to Thursday 9 a.m. till 12 and then 2 to 5, maybe you want to do it on a Sunday night. And if there are patients there and you can do it and tell them ahead and you can do it, you know, on your own terms, why not. And so I think that is that kind of culture and hierarchy is what we're beginning to break the back off in COVID and less so in terms of, wow, there's so much more technology out there. The technology is not new. It's been around 20 years, right. It's the application of that technology. And that's really where the thrust of my career has been, is I'm not a technologist per se, but I apply those technologies to ensure that they work and by work, means deliver that value proposition. So that's high quality healthcare, whether that's reasonable costs of healthcare, whether that's access where everyone who needs that health care, whether that's the experience that everyone deserves from a patient and a provider perspective. So that's where the, in my mind, the innovation needs to head to deliver on its promise. And right now we have a lot of innovation that gets turned on, and then doesn’t deliver. And the reason it doesn't deliver is it doesn't engage with the people in the process in terms of the workflows, right. The current, but there's a lot of engage in those, and then on the outside of these engage with the desired value proposition. 

Salome: Wonderful. No, that I mean, absolutely fascinating. It's true. We're always talking about an exponential growth in the technology center, we're thinking about forms of technology that are going to outpace us and often the question is how are we going to better incorporate technologies that we already have and that we're going to have to deal with, as opposed to creating technologies that we know have a purpose that we know will have a specific use in the specific industry hypothetically, but it's amazing to see how different forms of technology can be repurposed in the healthcare field and beyond that. I personally think COVID has been a time, a great example of, if anything, resilience, in multiple sectors and it's been a forced conversation. It's a bit unfortunate that it had to come to a pandemic, maybe, to make people think a little bit differently. We could have had telemedicine a long time ago, but if it'll open the new chapter that's a bit more positive then you know, we have to be at least happy for that, I suppose. 

Dr. Agaval: Yeah, I fully agree with you. It's sad that it took this, but then you've got to make the best you can out of a crisis and that's – you know, when the crisis happens, you know, I wrote an article over a year ago and linked in about the silver lining of the crisis of the pandemic. And it's just so, so important that we make good on this where we are right now rather than become complacent where we are now. 

Salome: Right. No, of course. And I mean, I would say that beauty can be a great counteracting force to complacency. It's a creative process. It's something that has, you know, requires an active investment. And it's, I'm sure that people in the scientific and the medical and the tech world are must be very interested to be, you know, hearing and speaking of these of these concepts, because it's not common to think of maybe how something in the artistic world can, you know, bring such value in another sector and thinking of beauty as a product and not necessarily – I mean, thinking of beauty as an experience, of course, but also thinking of it as a desired output and a desired product is a very interesting concept. 

Dr. Agaval: That's what makes it beautiful, right. Thank you, everyone. How good day. 

Salome: Thank you, Doctor Agarwal for sitting down with me today. And to everyone listening, please tune in again soon.