Raising Productivity, Performance and Revenue in Surgical Services.

5,000 Hours of Proximie - A case study into its impact at a large hospital partner

Executive Summary

Proximie was deployed across surgical departments at a hospital partner in April 2022. With a brief to boost training and development opportunities, improve operational efficiency in the operating rooms (ORs) and ultimately raise standards for patients, Proximie has been adopted by more than 125 practitioners (including consultants, trainees, registrars, OR nursing teams and trainees), and used to capture around 5,000 hours of surgery in a 20-month period.

With video capture taking the lead, Proximie has been pivotal to revamping collaboration and knowledge sharing across surgical teams. It has been used to create more flexible and dynamic training opportunities, increase surgical throughput by coordinating procedures across different ORs, speed up the onboarding of new medical device systems, and to create new commercial opportunities for the hospital through remote education programmes.

The Challenge

Like most surgical service providers, the strategic goals of the hospital’s clinical and commercial leadership teams coalesced around three clear objectives:

Improving OR efficiency: Operating rooms are the most expensive part of any health system (NHS Providers estimate the surgical costs average out at more than £560 per hour per operating room) (1).   We also know that OR productivity remains down on pre-COVID levels (2).  Improving workflows to enhance productivity, utilisation and throughput is critical to reducing costs and tackling the waiting lists caused by COVID.

Enhancing workforce training: The development of a more skilled, flexible and efficient workforce is viewed as central to strategy to improve OR efficiency and patient safety. But COVID-19 dealt a huge blow to surgical training provision, denying trainees an estimated one million training opportunities (3).  With access to ORs for in-person observations already heavily oversubscribed before the pandemic, teaching hospitals have little prospect of catching up these ‘lost years’ using conventional methods, and desperately need a new paradigm for making training more agile and effective.

Raising the bar on patient safety and outcomes: Multi-faceted challenges such as workforce, training, and capacity, are having a significant impact on patient safety and experience. Adverse events in ORs have increased 30% since 2015 (4). On average, this has created an additional £3m cost burden per NHS Hospital Trust (£ 134,000 per OR for an average Trust with 22 ORs) (5).  Furthermore, every day across the UK, on average at least one patient experiences a Never Event during surgery, a potentially life-changing incident that, by definition, should never happen.

The Proximie Solution

Proximie provides the technical infrastructure for adopting a more joined-up approach to surgical services across a hospital. By serving as a centralised hub that integrates OR operations, the Proximie platform helps to improve knowledge sharing, oversight, collaboration, and strategic development. These are all key to boosting efficiency and raising standards in terms of OR workflows and productivity, patient safety and outcomes, and training and education.

In this case, the solution we provided to the hospital had three core strands.

1. Video Recording and Telepresence for Remote Proctorship, Preceptorship and Personal Development

Surgical teams have made extensive use of Proximie’s video capture capabilities for training and development purposes. For example, the use of Proximie quickly became ingrained in robotic surgical training across the hospital. Fellows, consultants and registrars now routinely use Proximie to record their own practice for later review and reflection, and to share potential learning opportunities.

The hospital has established its own digital library of best practice examples, which can be used in lectures to showcase techniques and procedures, or else be accessed by trainees to study in their own time.

Livestreaming of procedures, meanwhile, has helped to create more flexible observation opportunities, as well as options for remote guidance.

In a period of 20 months, Proximie was used in 5,000+ hours of surgery.  The general sharing of best practice via video, whether live or in recorded form, also extends to nurses and SCPs. More than 125 consultants, registrars, OR managers, anaesthetists, nurses and SCPs are signed up to use the system.

All of this has contributed to a more scalable, agile and efficient approach to training and development. Moreover, where Proximie is used to deliver more than 10,000 additional training hours compared to using only traditional approaches, there is an efficiency saving of ~£700,000 in equivalent Consultant cost (6).

2. Improving OR Team Productivity: Proximie Central Hub and Accelerated Medical Technology Adoption

The Proximie platform supports team productivity through a combination of data sharing, communication and collaboration tools. At this hospital, it was used specifically to drive improvements in utilisation and workflow efficiency. Through recording and labelling procedures, Proximie was able to identify that one third of total procedure time has no surgery taking place in it, and 83% of turnover time is inactive (7).

To this end, we were central to the creation of a ‘Proximie Central Hub’, a telepresence link between ORs and anaesthetic rooms, allowing for the coordination of multiple procedures at once to increase efficiency and throughput. This was used in an approach to clear backlogs in radical prostatectomy procedures.

NHS research has found that data-led improvements in workflow and operating room organisation could increase patient throughput by 16.8% and save NHS Trusts an average of £7M a year in efficiency gains (8).  Better use of data also supports teams in achieving better outcomes for patients, by enabling more accurate benchmarking of standards. The key to unlocking these improvements lies in securing objective and reliable data from the operating room initially. Proximie’s work with a current NHS hospital demonstrates that manually collected data from EPR is inaccurate by more than 2 min in 59% of times compared to Proximie’s data (9).  

Proximie is creating a single source of truth for the operating room, providing insights into efficiency metrics like procedure length, inactive turnover, and infection prevention factors such as door opening and staff numbers.

The benefits to team productivity extend beyond the OR and even the hospital. Proximie also allows external parties like medical device representatives to ‘scrub-in’ to remotely assist and support with the use of new technology, shortening adoption cycles and accelerating the performance benefits. An example of this in action included Proximie being used to support the onboarding of a major new robotics system for the urology department and giving practitioners across the hospital the opportunity to observe it in action, speeding up their own training on the device.

The SCP team leader at the hospital explains: “ For the past few months, my SCP team and I have been using Proximie to support the robotic services across the hospital. All 10 of us have access to the Proximie library to watch and learn from the procedures before we even step into the operating room. For instance, my team can now observe how to safely dock and load the robot, saving us time and ensuring we’re prepped for action. And for me personally, Proximie’s live environment allows me to remotely support my team wherever they are at different sites, especially when they are tackling new robotic specialities. Proximie is an excellent platform to support my team’s education and workflow.”

3. Creating New Revenue Streams with Dynamic, Interactive Public Training Initiatives

In addition to internal training and development, Proximie has allowed the hospital’s commercial team to explore new revenue streams within the field of surgical education. By combining recorded procedural videos with live conferencing and remote observation opportunities, the hospital has put together fully-fledged training programmes, including virtual observership programmes, with the ability to reach participants all over the world.

Consultants at the hospital have been invited to deliver lectures and host master classes by international institutions, raising their profile as experts in their field and contributing to a wider exchange of expertise.

In total, Proximie has been used to facilitate and deliver 35+ educational events and live conferences. The use of Proximie has increased attendance at events hosted by the hospital, increased revenue flow and improved the experience of delegates.

About Proximie

Proximie is a software platform that captures data from all sources across the OR, including video, audio and from medical devices and robotic systems.

Proximie is the only platform that has the ability to capture video from four different viewpoints simultaneously, providing high definition, low latency, 360-degree views from every angle. For every procedure in every speciality, this level of detail provides robust and comprehensive insights suitable real-time collaboration, remote learning, evidence-based development, medical device onboarding and more.

The Proximie solution has three core parts:

Telepresence: Livestream video-based real-time collaboration tools that enable remote consultation, tele-proctorship and tele-preceptorship during surgeries, regardless of location.

Content Management: Centralized video libraries capture a wealth of surgical knowledge and expertise that can be used as educational resources, for self-development, as assessment tools and for post-procedural review.

Data Insights: Proximie delivers a single source of truth for events in the OR, enabling access to and sharing of surgical insights, and the benchmarking of best practices.

Learn more about Proximie and connect with our team to unlock potential at your hospital.

Request a demo here


(1) https://nhsproviders.org/media/1128/operating-theatres-final.pdf
(2) https://ifs.org.uk/articles/there-really-nhs-productivity-crisis
(3) https://www.telegraph.co.uk/news/2022/01/08/britain-faces-surgeon-shortage-cancelled-operations-leave-graduates
(4) https://www.proximie.com/press/proximie-on-sky-news
(5) https://www.proximie.com/resources/efficiency-savings-calculator
(6) https://www.proximie.com/resources/efficiency-savings-calculator
(7) https://www.proximie.com/blog/the-powerful-data-points-that-can-transform-your-hospital
(8) https://allcatsrgrey.org.uk/wp/download/surgery/Theatre_productivity_ report_ final.pdf
(9) https://www.proximie.com/blog/the-powerful-data-points-that-can-transform-your-hospital