Delivering superpowers to surgeons: better surgical outcomes in Proprio's pursuit of perfection

Today’s surgeons must operate with outdated technologies under pressure, which requires a surgeon to constantly switch their focus in order to interpret static 2D information in a dynamic 3D space in high-stake environments that require precision and accurate live data.   

In this episode, Pearly Chen talks with Proprio CEO Gabriel Jones about the inspiration behind Proprio and how the company’s tech is leading the way towards a future of better surgical outcomes. Proprio is a surgical navigation company that superpowers surgeons by combining XR, computer vision, machine learning and robotics. 

Episode 04: Show Notes 

Today, we’ll cover how XR can transform medicine, specifically surgeries, by giving surgeons the superpower to see and work better for patients.  Tune in to hear how Proprio brings world class medical care to every human. 

Key Points From This Episode:  

• An introduction to Proprio and how the company enhances a surgeons’ abilities. 
• Proprio is tackling challenges in the operating rooms with new technological breakthroughs and creating new opportunities.  
• How Proprio is elevating surgeons so they can actually begin to think about new, innovative treatments and approaches in their work.  
• Surgeons have begun to grow accustomed to this technology and begin to adapt to this new operating way.  
• Proprio has brought joyness and delight to many doctors, which is rare in medicine.  
• Proprio is the only company to apply rendering techniques in the operating room and diminished the use of X-Rays, which subsequently put surgeons at risk for developing cancer.  
• Proprio gives surgeons more natural interfacing tools to enhance performance, it is also smarter, better, faster and cheaper so  medical operations are as simple and effective as possible.   
• Gabriel closes with his personal motives behind building a company to address problems in the surgery industry.  

Tweetables: 

“This is similar to the concept of calm design that I think Proprio is really at the forefront of, which is technology at its best where it's designed really, really well and very thoughtfully implemented should just melt away.” - @aGabrielJones [0:09:18] 

“Overall, we think technology can help bring the physician back to the direct interaction through technology with the patient. I think that should be our overarching goal, not just to implement technology for the sake of selling a product or launching something that's really cool.” - @aGabrielJones [0:10:42] 

“So if we could reduce the need for surgeries like that and not be over-focused on driving more surgery, that's not the goal. The goal is perfection. If you're going to do surgery, get it as close to perfection as you possibly can. I think the data and computation is really one of the best ways to, over time, achieve a little bit more of that perfection.” - @aGabrielJones [0:25:08] 

Links Mentioned in Today’s Episode: 

Proprio website
Gabriel Jones on LinkedIn
Gabriel Jones on Twitter
Pearly Chen on Twitter
HTC VIVE website
HTC VIVE on LinkedIn
HTC VIVE on Twitter
HTC VIVE on Instagram
HTC VIVE on Facebook 

Transcript

[INTRODUCTION] 

Pearly Chen: Welcome to Good Vibes with VIVE. I'm your host, Pearly Chen. I'm an executive with global technology company HTC, and as a mother of three young girls, I loved building and investing in profound immersive technologies that make a positive difference in people's lives. Each week, I speak with founders at the forefront of VR, AR, and the metaverse. All of them inspire me, and some I've been lucky enough to back as an investor. Tune in every week to hear some of the most inspiring closed-door conversations, and walk away informed, inspired, and full of good vibes. 

[INTERVIEW] 

PC: Hello and welcome back to Good Vibes with VIVE. Today, we're going to talk about how XR will transform medicine, my personal favorite topics of all time, specifically, today, though, as it relates to surgeries by giving surgeons the superpower to see and work better for patients. You heard that right. I was super fascinated by this notion that beyond surgical training and patient engagement, XR can actually be used as an interface to augment surgeons' capability in the live operation. Joining me today is the man who opened my eyes about this idea some three years ago when I first invested, Gabriel Jones. Welcome to the show. He's the CEO and founder of Proprio. 

Gabriel Jones: Hi, Pearly. I'm really excited to talk with you about this, and there's really nobody I can imagine who can bring the right energy and understanding to this topic more so than you, so I'm really excited to dive in with you. 

PC: I'm super excited today that I get to share these amazing conversations between us with the world today. Usually, these are closed-door conversations. I'm incredibly inspired and enlightened by a lot of this conversation that I have with Gabe and other founders. But, today, I get to share it with the world, especially relating to a topic that is deeply interesting and fascinating to me. So, Gabe, let's unpack this for the audience. What is Proprio, and how exactly is it giving surgeons superpower to work better for the patients? 

GJ: Yeah, yeah. Thanks, Pearly. First, let's start with the word itself. Proprio refers to proprioception, which is really your brain's ability to build a 3D map for the world around you. It starts in childhood when we start to understand how our hands and our eyes and our body relates to itself and you start to build that 3D map of the world that allows you to pick up objects and know the difference between a very ripe peach and an aluminum can. Throughout your life, you're just building that 3D model and that feedback mechanism and really the data for the world around you. It allows you to close your eyes and navigate the world through that picture that you built. Fast forward to today. You have surgeons who leverage proprioception and their understanding of the human anatomy to be able to perform at a very, very high level and know where the bony structure in the body is versus the heart or softer tissue and really the differences and the subtle nuances between those tissues. 

We named the company Proprio because what we're doing in enhancing the surgeon's ability to build with those 3D maps of the world and understand how the human anatomy is dynamic and how it behaves as they're providing care to patients. So what Proprio does is really build those kind of models for the performance of surgery and update them in real time, giving surgeons the ability to navigate the anatomy in a much more natural, intuitive, and informed way. I think we're going to talk a little bit more about that, but the concept of proprioception is something that really resonates with surgeons. Every doctor knows what that means, and it resonates with their own definition of what value they bring to the relationship with the patient. 

PC: There's a lot of different technical components that we can unpack here today for the audience relating to this topic. But, first, maybe let's take the audience into the operating room today where surgeons are performing their surgeries. Of course, I can imagine the operating room to be stacked with very expensive, bulky, complex hardware and machinery, which are difficult for the surgeons to actually navigate in between getting all the information they need in real time and then, meanwhile, really taking their eyes from the patients, right? So what Proprio is trying to set out to do is to combine a lot of these different new technological breakthroughs in computer vision, machine learning, of course, you'll talk about robotics later and XR's interface, to essentially get them a new way of seeing in the operating room. Is that right? 

GJ: Yeah. Well, it's on the shirt right here, the new way of seeing. Obviously, I'm a little biased, but... Yeah. So talking about unpacking, there's a lot of really interesting topics there, so let's start with what surgery is like today. It's really all about workarounds. Most people may not think this, but surgeons are extremely creative and adaptable. Right now, they're using all that energy to adapt to a very cluttered operating environment with a lot of equipment that is stationed around the operating room. The technological origins of that equipment goes back 50, 100, 110 years. We're talking turn of the century with microscopes that were developed prior to World War I and then eventually applied in 1950s to perform surgeries, X-rays that were developed in the 1890s and then applied in World War I in the field to actually provide care. So now you're talking over a century old in those technologies. 

Fast forward to now, you can pay a million dollars for a surgical microscope from a great microscope company like ZEISS that goes back over a century, but that technology hasn't evolved tremendously. It's been kind of incremental over time. So you go in the operating room, you have a big microscope, you have maybe an X-ray machine called a C-arm or an O-arm or a CT machine. These things cost millions of dollars, the systems that are there, and they're very bulky. It takes 30 to 40 minutes to set up just to use it one time. The doctor's trying to navigate in the anatomy off of that 2D picture that's presented to them from this very expensive machine. If you can imagine, we're all 3D thinkers, right? We build that proprioceptive model of the world, and then to hand a surgeon or an architect a piece of paper essentially, a 2D model, and say, "Go build that house in 3D," or, "Go solve that anatomical problem or that pathology, that condition that that patient has. Here's a 2D model to work with." 

GJ: It really doesn't make a lot of sense for us to ask humans to do that translation back and forth between 2D and 3D so much. We did it out of necessity, and that's what the OR looks like today, is a picture that has advanced over the last 100 years with these innovations, but, really, the most recent breakthroughs in that operating room occurred 30 and 40 years ago, and we've been in a long tail of technological refinement for decades. So our view is not necessarily that it's beneficial to add a lot more technology, bulky items, and very expensive products into the operating room. We should actually be looking at what we can take out, what we can remove. This is similar to the concept of calm design that I think Proprio is really at the forefront of, which is technology at its best where it's designed really, really well and very thoughtfully implemented should just melt away. 

PC: Just disappear, right. You don't even realize it's there. 

GJ: Yeah, exactly. XR is a computational interaction paradigm that should advance the pace at which technology disappears, and that's why we're particularly excited to be alive today and working on the intersection of all these technologies in the operating room, which is currently a very crowded place, but it can get a lot smarter. There's a lot of room to improve it, and it can get a lot more efficient. 

PC: I love that. In your perfect scenario, where Proprio combines all these cutting edge technologies to help surgeons see better, what is the ideal scenario of an operating room? What would you remove, and what is going in in place of today's expensive and bulky equipment? 

GJ: Yeah. The idealistic view would be that you could actually distill it back down to where it started, which was a physician/patient direct human to human interaction, right? That's the Hippocratic Oath, "First, do no harm." That's why most practitioners got into medicine, with a very humanistic motivation to be there, and then all these other realities of the current environment of healthcare, the industry itself, how hard it is to practice, how exhausting it is, the red tape of medicine, all that got in the way. So, overall, we think technology can help bring the physician back to the direct interaction through technology with the patient. I think that should be our overarching goal, not just to implement technology for the sake of selling a product or launching something that's really cool. So I think that's got to be a fundamental pillar. 

The vision that we have is that the doctor should have exactly the information they need at the right time when they need it in the way that they need it. So let's take robotics for an example. Today, in something like spine surgery, robots are very early in their implementation. So if we thought about a hype cycle or an adoption curve, it's early adopters, product market fit is not there, and, primarily, robots are being used to guide a drill or guide an implant like a screw to be hopefully accurately placed in someone's back or their spine to add some structural support to that spine, which a person may have been born with a deformity or they may have encountered some degeneration, is what it's called, just in the natural course of their life or an injury. So what you're doing is going in and trying to provide additional stabilization for that spine. 

Today, the robot, which sounds really cool in the operating room, right, this concept of robots doing the surgery for us, we're in very, very early days where product market fit is not there and it's still being sought after. So you have pretty simple applications of robotics in many areas, but the vision is there, which is both humans and robots need to see better and know where they are in 3D space in order to gradually over time start to automate some of those functions. This is where it gets very interesting, right? We talk about the human side and the empathetic side of medicine and the practice of medicine. I get very excited when I think about the height of the curve of the mind share and the focus and the exhaustion that comes with being a surgeon and performing hours-long surgeries. Well, if you can reduce that mind share, that stress level, even for an experienced surgeon, does that free up the ability to be more compassionate, to be more focused, again, on that patient? 

This is what we're chasing. So I think it's not about a robot performing all of the surgery from day one from start to finish and the doctor's there in the background just approving the steps. It's definitely going in that direction, but we should be more focused on how we can enhance what the doctor can do and what they can provide and the value of that care and the tracking how effective it is as opposed to trying to say, "Oh, we're going to limit... The human is only going to be an airline pilot just approving certain steps at a certain point." That's not going to be a one size fits all solution any time soon. We should really be focused on what do humans do best and how can we enhance that. 

PC: I love how you jumped two steps ahead into the deep implications of what technology can do in promoting more empathetic medicine, connecting the doctor to the patients better, and to bring out that humanistic motivation of medicine and better patient care. I was thinking, to even go on more the surface level, to talk about the technical components of what this means... So you would have an array of sensors still on the operating theater, and you would collect a large amount of data to be rendered and played back in the light field format, and how computer vision and machine learning all comes into play and robotics to help surgeons who would be wearing a mixed reality headset to collate all this information in a spacial way during live operations. That's a super fascinating idea for me and I believe for anyone that's listening now as well, so let's help them understand a little bit how each of these components play a role and come together to make that possible. 

GJ: Sure. Sure. The best analogy I have come across is, depending on the demographics of your listening audience, MapQuest. So if you remember MapQuest, it was this revolution in technology where you could get a customized map that you would actually physically print out of your print, probably a dot matrix printer at home. But once it printed out many minutes later, you would actually have a customized map from where you wanted to go in the Bay Area, Seattle, wherever, and it was made for you. That was really exciting because you could actually take that and go somewhere and have an optimized route. The problem was that it was very static. If anything changed, if there was traffic or construction or an accident, anything, or if you changed your mind based on information you got, you got a phone call on the way over there, you couldn't make those kind of changes easily. 

If you fast forward to now, we have Google Maps, Google Earth. We have real time information on the way between point A and B where you can take a completely different route. You can have real time suggestions about a restaurant to stop at and get some food. You can make all these kind of adjustments as you go because we have things like satellite information. We have positional information from your phone. You can even interact with voice assistance as you're going. That analogy of 20 years or so of development of just consumer mapping technology and the ability to layer on additional valuable data is, I think, a very valuable analogy for the operating room. 

So, in the past, we were in MapQuest, we had X-rays, we had CTs, we had MRI, that kind of stuff, but how you would access that imaging and how it would be updated in real time was really a limitation. So now we've invented a sensor system that used to take up an entire room, and now we've miniaturized it. It's very similar to the concept of the immense computing power you have in your hand being as powerful or more powerful than the Apollo missions, right? That's where we are right now in the consumer space, and we're trying to bring those thoughts and those capabilities into the operating room. Nobody had invented a compact sensor system that was multi-modal and had all these different sensing capabilities, so Proprio went and invented that system. It's the first of its kind, and it does, as you alluded to, this real time mapping of the world in front of you. 

What that does is it allows the surgeon to actually be able to visualize in a much more natural way, 3D, in real time what's happening in front of them, both at the surface and then leveraging other modalities like CT to see beneath the surface. So what that really will enable a surgeon to do is not only plan the surgery, which, as you alluded to, training and planning is super powerful tools in mixed reality. But then no one has really been able to take that into the operating room effectively and be able to interact with an updating map of the scene, that Google Maps analogy. So now that technology is being brought online. We believe we're the first to invent and develop that technology, and we're just really excited to see where surgeons, many of whom we've been working with for multiple years to develop the technology, where they take it. 

So back to that creativity, once you're freed up from all these other encumbrances and having to think about all these workarounds and you actually can be creative in your job, we all know this from our day to day, then you get to think about new and interesting things that you can do, and technology can enable that. Well, surgeons really haven't been given a lot of those tools, and so now, with the ability to interact in real time, we think they're going to come up with really exciting new treatments and approaches. We can't speculate too much about what they will come up with, but giving them the tools and the opportunity to create and adapt and invent is a really exciting premise. It's very cool to be doing that right now when it wasn't possible before. 

PC: What are you observing so far in some of your pilot training scenarios? I know we haven't gone live for a live operation. Still, a lot of conversations are underway. But what are you observing as surgeons can take away some of those really complex cognitive loads and be more present and focused on the creative task so to speak, which is a very interesting way to think about performing medicine? 

GJ: Yeah, absolutely. What we observe is, first and foremost, that when you build trust with the system, you can observe the surgeon within about an hour's time start to adapt to operating in this new way. In a way, you don't want to force a surgeon to adapt to a new workflow because they've trained really, really hard and they've got tens of years of experience dealing with the realities of the operating room, which is oftentimes you're in there solving a problem because you discover something while you're working in the anatomy. That's really what great surgeons do, right? They're adaptable. So if you can present them with 3D views that are real time and immersive and enable them to understand where to go and maybe where not to go in the anatomy, that's really exciting because they can then focus their perception on the performance of the surgery itself. 

So an example would be in a spinal fusion surgery, doctors are often, rightfully so, concerned about and thinking constantly about and taking X-rays to adjust to where they are in the anatomy. Situational awareness is what they refer to it as because they don't want to, what's called, breach the other side of a vertebra. There's a nerve bundle there. There's all sorts of things that can go wrong if you do that. But if they have a full understanding of the 3D anatomy and where they are in that space, then they can build some trust in a system that then says, "Okay, I can tell you if you continue on this path, you are likely to breach through that bone and then bad things will happen for the patient. This is how much space you have left before something like that is likely to happen." 

That's just a tool in 3D that they didn't ever have before, so you can watch it happen and cool things are said out loud, like, "Wow, this is cool." When you see a doctor performing in a cadaver study, for example, and they're operating on a human body and they go, "Oh, this is going to just totally free me up," there's a bit of a joyousness and a delight that is rare to see in medicine. That joyfulness is something that we revel in, and it's really cool to share with our team those moments. We're seeing more and more of them these days. So that's one I reference, is that situational awareness. Understanding where you are in 3D builds trust, and it's going to enable the surgeon to then think several steps ahead, also in 3D, and then eventually, we think, perform not only better in the surgeries they're doing today but in ones that they'll dream up and solutions that they'll invent in the future. 

PC: Wow. It's very interesting to imagine what that could look like. It's intuitive to understand the benefits of bringing all these different images, pre-operative images, and live information together in the same spacial view so that it's easier for a surgeon to understand in real time. But there are also a number of other benefits that new technologies like this can bring to the table, such as precision, for example, right? Magnification is being done with a microscope today. It has certain limitations, optical limitations. How does Proprio's system, for example, enhance that, and what are some other areas of benefits that we are talking about here in disrupting the operating room technologies? 

GJ: Yeah, absolutely. That's one of the most exciting areas. Really, we believe we're the only company that's been able to apply a rendering technique like light field rendering in the operating room. I would estimate that we're using maybe five percent of that capability today, which is very exciting because you can imagine 20 times as much efficacy and innovation happening on top of a platform like this. We're in the very early days of that. So, today, we're simplifying everything by integrating navigation and visualization together, right? Really, there's only one tool that does that, especially in 3D, and that's akin to taking two million dollar pieces of equipment and combining them into one. We talked earlier in this conversation about what can you take out of the workflow, what can you take out in the operating room, and even out of the bottom line for the hospital. They simply don't have to purchase that very expensive piece of equipment that's hard to maintain and calibrate and all those things. That's exciting for lots of bottom line reasons and reasons of efficiency in setting up that equipment. 

But what gets really exciting is the ability to go back and forth between these modalities in real time within a workflow that the surgeon can then adapt and be more efficient. Think about it this way. If you wanted to go from a navigation system that exists today, so you can navigate off of an X-ray in the operating room, it's 30 to 42 minutes or so to just wheel in that machine and take one shot of the anatomy. You expose the patient and yourself and your team to radiation, and orthopedic surgeons contract cancer at a much higher rate than the regular population. So just being able to impact that one aspect of it, you won't be using X-ray quite as much or at all in some cases in the future, that's exciting and it's returning some of the care to the physician that the physician is making these sacrifices to provide to the patient. I think that's really exciting for us at Proprio. 

But even being able to then jump off of that into real time immersive visualization within the same tool is a new concept, which we think is very exciting because it's really combining microscopy and navigation together, existing modalities, but making it much more seamless and intuitive to interact with. So I think that's the starting point. In terms of where light field and these technologies could go, really, the sky is the limit. If you think about the human eye, you have a different resolution at the center of your eye versus the side. We've all experienced this, and it makes sense. That's really a computational and a hardware problem, right? So with light field, we have the opportunity over time to solve some of these computational opportunities, like what is happening in the periphery and what is the object over here, again, that situational awareness. ML, AI, and computer vision are really good at these kinds of problems. Feed it enough data, and a neural network can tell you what is in the periphery of your vision with quite a bit of certainty. Those are the directions that this technology will go, recognizing and differentiating anatomy. 

So, over time, we expect that a lot of algorithms will be developed to differentiate cancerous versus healthy tissue so when a surgery is performed, you don't have to remove quite as much of that tissue and the patient can recover more directly and hopefully does not need that second or third surgery for the same pathology. That's very exciting. If you think about breast cancer, for example, breast cancer patients end up having two to three surgeries for the same pathology. That's just absolutely damaging to the anatomy, the psyche, not to mention the cost and the outcomes, right? So if we could reduce the need for surgeries like that and not be over-focused on driving more surgery, that's not the goal. The goal is perfection. If you're going to do surgery, get it as close to perfection as you possibly can. I think the data and computation is really one of the best ways to, over time, achieve a little bit more of that perfection. 

PC: So it sounds like a system like this can not only give surgeons more intuitive, natural interfacing tools to perform better. It's also smarter, clearly a lot of intelligence that can be presented in the operating room that is not possible today without data, computer vision, robotics, and XR interface. It can potentially give patient better outcome as well in terms of safety, giving the surgeons more possibility to be present, not taking their eyes away from the patient during operations, and more efficient. It sounds like cost efficiency could possibly be achieved as well compared to today's modalities. 

GJ: Yeah. It's all interconnected. For lack of a better approach, it's useful to describe it as better, faster, cheaper to begin with. There's the coolness and the wow factors, but what we're really after is, at the end of the day, providing better care and being able to verify an approach and guarantee. Essentially, that's what we all want from healthcare, and that's why we're doing this, is can we get a little closer to I have an understanding of what my outcome is going to be as the patient and, frankly, as the physician. I can have a better understanding of what I'm getting into in the case, in the surgery, and have the tools I need to perform approaching perfection every time. That's a lofty goal, and it will take time and data, quite a bit of it. But we have to get started on that many-year, decades-long goal of pursuit of perfection in surgery. 

I know so many surgeons are already motivated in that pursuit. They're doing tremendous research 24/7 across the world to solve these problems in human pathologies. So you have a very motivated workforce, and that's really exciting because if you give them the right tools, they will go and try to solve these problems. That's what we're excited about here at Proprio, is really being able to give those tools to them. I can't tell you where they're going to take it. We have some ideas about what 25 years out looks like. But the exciting piece is the not knowing and that there is room for creativity in providing care. 

PC: I understand that the revisions to spinal fusion surgery alone is costing billions of dollars in the US alone, and so I love the notion of how you're inventing or reinventing surgical technology not for achieving or delivering more surgeries for the bottom line but for pursuit of perfection. If a surgeon can be empowered, enabled to deliver better care thanks to technology, data, computer vision, and XR, then there can be less harm done to the patient and better care achieved. When that interest is aligned with the patient's health outcome, the society can be enhanced as a whole in a much better way, and hopefully all the commercial framework catches up with that as well. It's very much outcome-driven, and I love that. 

GJ: Yeah. Maybe it's a strange thing for a founder and a CEO of a surgery company. 

PC: Less surgeries. 

GJ: Yeah. We tend to think about it as a continuum, right? It's a patient continuum, and it's a physician continuum, and across all that entire continuum, there's an opportunity to better understand with more certainty what are the causal relationships and what are the correlations. What does the balance of a person walking around with an Apple Watch on tell us about what they'll need in six months or six years? Then go post-surgery, right? Are we able to map and monitor the balance and the pain level and even the sleep quality of a patient who's had surgery six months or six years ago? What can we understand about what they're going to need and what their needs are at that particular moment? 

I think we're very much at the inception of that exploration. Thankfully, again, we have the technologies coming online or already here, and it's really about mapping and stitching together all those, for lack of a better term, sensor systems, and where we do have a sensor system, applying it and extracting the data and deriving the insights, and where we don't, like Proprio, we have to invent a new way to capture those data and process them so we can analyze them and then develop the insights that'll allow us to make changes and improvements. What's really exciting is we're now mapping that entire continuum, which should lead to, yeah, better care, better quality of life, less pain, and lower costs. 

PC: That sounds like an ideal outcome for everyone, every stakeholder in the society. So hopefully Proprio will accelerate realizing this vision. Back to the personal motivation side, what really motivated you to build a company to solve this specific problem? You came from a very diverse professional background in law, in product development, in investment. Why surgery? Why surgical tech? What really motivated you start on this journey five years ago? 

GJ: Yeah. It's easy to look back on a life and say, "this chapter and everything makes sense," and I don't think that's really helpful to listeners because that's not how life works, right? We have a journey, and we go out into this world and hopefully are curious and open to new opportunities. That's really been my focus. I grew up in a very entrepreneurial environment, growing up very poor but with a great example of a very strong maternal figure in my mother who was extremely entrepreneurial by necessity. Just seeing that every day, how she hustled and was creative, really motivated me to seek ways to, in particular, provide, by leveraging technology, healthcare but also financial services for women and families in those kind of situations. So I worked with the Gates Foundation and the Grameen Foundation trying to leverage mobile devices to provide checking and savings account services to billions of people who live on one or two dollars a day. 

That led me into the Gates world and started to look at global health issues. I've been on the board of a couple of hospital systems and biotech groups and really just searching for ways to really find the right people and the right technologies to help solve some of these very large-scale challenges but opportunities in the world. I was very fortunate and continue to be in the people that have gotten involved with Proprio, from the founders to the team now, which is almost 50 people. The original founding team, I think, represents the diversity of thought and skillset that is required to do something this audacious. So you've got a world-renowned pediatric brain surgeon, Dr. Browd. You've got a professional who's an IEEE fellow, Cambridge, Intel Labs, Dr. Josh Smith, and his top PhD, Jamie Youngquist. Computer vision experts, sensor system experts. You've got people like Kenneth Denman, the chair of our board, who's my mentor, who's on the Costco board and a very accomplished entrepreneur himself. 

You just look across the entire team, and it's pretty reflective of that diversity of thought and that pretty singular focus on this kind of a mission. If I look back, was it obvious to me that we would do something like this or that I would seek out these people and connect the dots? No, that's not an honest answer. But it's been the different chapters of going to try to figure out how the world works, and what are these kinds of problems that are so large in scale that you have to be a bit audacious to tackle them, and then can you find some other folks who feel similarly and get them together and go start to chip away at that problem? That's been the most exciting part of what's been my life's work. 

PC: You have certainly convened a very multidisciplinary team that's really all stars with incredible pedigrees. Everyone has a very impressive background and really coming from, as you say, diversity of thoughts to be able to bring all these different technologies together to achieve something that is completely in another direction. It's very, very, very impressive. But, at that same time, I also look at your very compelling personal story of growing up in a very entrepreneurial household. I can't wait to meet your mother one day. Also, you grew up with three sisters, right? So as I was pressing you the other day about the lack of woman representation on your very impressive board of advisors, leadership team, I wanted to get you to talk to us a little bit more about how strong women in your household influenced your thinking on entrepreneurship but also leadership, how woman can and should play a larger role in the forefront of technology and reinventing societies, and how and what do you plan to do for Proprio to shift that to the right direction? 

GJ: Yeah. I totally agree. As we've talked about, especially in your role, being a visible, strong woman leader, which we need more of and we need to really facilitate and foster and create those opportunities for that to occur at a much greater scale. I've shared with you our frustrations, even though we have systems in place and, yeah, we're hustling and it's a focus for us and my team knows. We talk about it every day. But we're not doing well enough. It's a daily frustration. That's not making any excuses. It's just calling out what is there. It's a huge priority for us, but, yeah, you look at my board, and our board is fantastic and it's diverse in many ways, but it's all men. 

Because you are finding great partners who bring additional skillsets and create opportunities for the company to ascend another level of achievement and scale and scope and go international and get well-funded and all these things that you have to prioritize in building your company, and you make trade-offs, and those trade-offs can be really disappointing because you do have this other set of lofty goals that is, yeah, we shouldn't be aiming for 50/50 across the genders. Why is that our goal? Why not 70/30? Why not have me be the only man in the company? Why don't we set more lofty goals for these kinds of things, right? We need to ask those questions and push each other pretty much constantly, and I think that's something we try to do on our board and in our company here, but it's better served by having women in visible leadership positions because that's a signal to the rest of the organization, right? 

So one thing we've focused on is where can we find wins to start to build momentum around this topic. One thing where we have seen some very intentional, positive results is having women in leadership roles, whether it's a lead of a functional team or management positions where they're directly managing folks. So our goal has been to exceed 50% women representation in those roles, and to date, we've succeeded in that. I think we can do better, but it does signal to the organization, whether it's a more junior employee or more senior or kind of at the same level, "Okay, this is an important thing to the organization, and they're proving it in this way, and we expect that momentum to continue to build," and that, yeah, that should represent throughout medical and technical advisory boards, the board of directors themselves, the investor base, and the company, the team here. 

Yeah, but I won't lie. It's very, very difficult. The talent pools that are available are overrepresented with male participants. It's just a lot more work and effort to reach women where they are, communicate with them what the benefits of the organization and the mission are, and make it possible, make it approachable and accessible, for them to join the team and feel really fulfilled. So that's our burden but our opportunity as well, and we take it seriously. But, yeah, I won't tell you that we are succeeding across the board. We've had a few small wins, and we're trying to build on those. 

PC: Do you think it's helpful to set yourself some goals, and how confident are you in achieving a goal like 50% on leadership team, 50% on board of directors? I know these are not easy questions, and a lot of global technology companies and very large sites are trying to still tackle this problem. But what have you learned and tried that you think is working, and what is not working? 

GJ: Yeah. One list is a lot longer than the other, right? I think the right tool for the right job is a really important way to think about this and building momentum, so thinking about what does the board look like over various times. That's something that evolves with a company. What does the company workforce look like over time? What does management look like over time? So building momentum one team member at a time is the way that I've thought about it. Even if I have a sense of urgency and we have a sense of urgency about achieving some level of equity and equality, the reality is that the moment you reach that, something changes. So the organization's needs evolve and you have to be responsive to that. That's just a way of putting you're never done, right? You're standing on a balance board, and when you lean too far this way, you can feel it, but you're already leaning, so you have to lean back. 

Something we're doing now is putting people in position of leadership but also giving them opportunities to go out in public to talk, but we have to be sensitive, too. We don't want anyone in our organization to feel that they're being used in a tokenized sort of a way, right, as a token. This has to be something that someone wants to engage in. You're familiar with some of our team members, and I'm very excited that they're going out and talking more publicly about what Proprio stands for, what we're trying to accomplish, but you can't just hire a woman and put her in a position to be responsible for that. 

I think that's one of the biggest mistakes, talking about what doesn't work. In talking to a lot of CEOs, be they white males or otherwise, that are in my network, oftentimes, what happens is a CEO commits to things, shows up for the first couple meetings of a diversity and inclusion committee that is a good thing to start in an organization, and doesn't remain committed to it. I think keeping a promise is incredibly important. That's why I'm not afraid to talk with you about a topic like this in public, and I think more CEOs need to do that. Yeah, it's frightening because then you can be held accountable, but that's exactly what we need more of. 

The last piece I would share is it's a supply issue and it's an access issue. We don't have access to enough women to achieve 50% or more right now. That's why the momentum is very important. We have to continue to show these opportunities to both women and men out there that this is important. I'm excited that it's really difficult. I know this is counterintuitive, but it's very difficult to recruit a woman board member. Why? Because they're in extremely high demand right now, partly out of the supply, but part of it is that we are seeing changes in the way that companies are actively talking about board composition, company composition, leadership composition, and this is putting the women who are in those positions out there and available and have that experience, but they're in super high demand right now, which I'm ecstatic to see. It does make my job harder. That's a trade-off I'm happy to make because it means progress. 

PC: It's actually not customary for a relatively early stage company to talk so much about diversity, inclusion, or culture, but it is a topic that I love talking to you about because you're very unique in this way. Of course, you managed to scale the team in a very short period of time to a size of 50, which is very commendable in this space, but you also started early to think about what culture means, what building a workplace that everyone wants to be part of means, and as a CEO and leader, what delegating, enabling means to you. I was very fascinated last time when we talked about how your job has become letting go of those responsibilities and work scope that excites you the most, how you need to go find talents that are better at you than doing things and letting them do the things that you love doing the most so that you can give everyone of the A-list talent the most exciting, most promising type of a work to engage with. Talk to us more about that and how you think about motivating your team and your leadership principle in general. 

GJ: That was a pretty good summary. It's one of the hardest things to do because, especially as a founder or CEO, you've done all the jobs at some point. The thing you have to keep repeating to yourself is exactly what you said, which is you've got to hire people, bring them into the team, and then give them the important work. Otherwise, you won't be able to foster and develop great talent. They'll just go somewhere else. So even if it's just about the survival of the organization, even if I didn't have the motivation to do this anyway, we would want to do it, just to attract and retain great talent. The motivation for me is greater than that. I love seeing people succeed, and having just even a small role in that is very exciting to me. That goes back to my upbringing with my sisters and all that. So I'm fortunate that I've seen some of that and benefited from it and we're able to carry over some of that here. 

I think on a day-to-day basis if I'm not asking myself, "Okay, are you radically empowering people, or are you doing your job for them"... It seems like a very binary choice, but it is a spectrum, and we're always going to try to land on the radical empowerment side, which means people will take some things, and it'll be a bigger job than they've done before or it'll be something that stretches them and that's uncomfortable. From a leadership perspective, your job is to make that decision and stick with it and support them through that stretching and that discomfort because they're building new muscle and, at the other side of that, not over-engage and micromanage and do their job for them. Very tough to know when they do need that support, and you're going to be wrong some percentage of the time. 

In my view, you just factor that into the portfolio investment strategy of saying, "We're going to make a number of these kinds of investments. Some of them will be more of a stretch for this person versus this person in this role." I think about that as engineering versus creative and marketing and the levels of seniority and experience. So you're thinking about the whole portfolio and going, "Okay, this person needs a little bit more support and affirmation and clarity of purpose at this time," and you need to engage more on that at the beginning of them joining the team or taking on a very important project. Another person, you're going to let run for quite a while before you reengage, before you provide additional guidance. 

I think that's both the art and a bit of the science of management and leadership, is to know why you're doing that in the first place, to have a philosophy behind it and to try to stick with that so that your team knows, "This is how we do things here. It's not going to be terra non firma under your feet. You're going to have a lot of opportunities for growth." You tend to attract a certain type of person to that sort of a culture. If you can keep it consistently focused on growth and a growth mindset, then people can understand how they need to adjust and adapt to that and how they can grow really intentionally. That's what we try to achieve. We don't always achieve it every day, but that's certainly on my mind 24/7. 

PC: I love how self-aware you are as well on how you take joy and personal motivation from enabling others to do better and to succeed and, in this case, in Proprio's mission, enable more people to live a healthier life, to be more productive. Thank you, Gabe, for being with us today. We're going to wrap here, and the audience, we hope that you enjoy this conversation between us. I certainly enjoy it as much as I do every time we talk to Gabe. You can learn more about Gabe and the team Proprio's pioneering work on transforming surgical technology for better patient outcome using mixed reality, computer vision, machine learning, and robotics at propriovision.com. Thank you, Gabe. 

GJ: Thank you, Pearly. I can't wait to hear and see all your great work. 

PC: Thank you. We'll talk soon. 

GJ: Take care. 

PC: Thank you for listening. Please subscribe and share this podcast with a colleague or friend that you think could use some good vibes. Learn more at vive.com, and follow @htcvive on social media. See you next week.