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Hello, good evening. Good afternoon. Good day, wherever you are in the world and welcome to the Black Belt Academy of Surgical Skills. My name is David o'regan. I'm a professor in the Medical Education Research and Development Unit of the Faculty of Medicine at the University of Malaya as the immediate past director of the Faculty of Surgical Trainers of the Royal College of Surgeons of Edinburgh. If this is your first time joining the Black Brown Academy? Thank you very much. Indeed. And if you're returning, I am very grateful tonight. We have people from Bangladesh, China, Egypt, Malaysia, Nigeria, Pakistan, Romania, Saudi South Africa, Sri Lanka, Uganda USA UK and Zambia, I like to introduce on a regular basis, other elements that I think are critical to surgical skills. And it so happened that a couple of weeks ago, an acquaintance and friend, Doctor Peter Waltham was asking me a question and it suddenly triggered me to think data daming. The guru of business said in God, we trust but everybody else requires data. Now, Peter trained in medicine at Keys College and we just ascertained that I went for an interview at Go Keys at a similar time that he was at medical school. There, went on to Saint Thomas's London and he will tell the story became the first medical doctor to undertake a full time MBA at the London Business School in 19 eighties. Peter is the founding managing director of Dendrite Clinical Systems and has built a company into a world leading organization providing both hospital and departmental clinical databases and national and international clinically registries and platforms for a wide wide variety of medical and surgical specialties with clients in over 40 countries for well over 25 years. And I've known Peter since 1996. He has been a regular faculty, guest speaker on the international stage, lecturing about the value of registries at scientific meetings around the world. And for this work, he was awarded a fellowship of the Royal College of Physicians, specifically in 1996. And again, I started my cardiac career around that time when I was at the London Chest. Peter initiated the setup of the adult Cardiac surgical Registry of Great Britain and Ireland. And in 2003 established the European Cardiac Surgical Registry for EAC, which ultimately merged and analyzed over 1 million cardiac surgical procedures with records submitted from 29 countries for my operating from trainee and consultant for 23 years will also be on that database. Since then, Peter and his team have been responsible for building and implementing numerous other national and international cardiovascular registries around the globe, including Urimax for Mechanical Circulatory Support registry. Again for a and the ongoing internal minimally invasive extracorporeal circulation versus conventional cardiopulmonary bypass clinical trial. Welcome Peter and I'm really privileged and delighted you could join us. So to start, you trained as a doctor and left to explore data to explain why that happened. Sure. Thank you David. Firstly, thank you very much for this kind invitation and for your very generous words. And I hope, I hope my story will resonate with some of your audience and also give them some reflection that you don't have to be a clinical doctor at the front edge of medicine and surgery, seeing patients to make a positive difference to clinical outcomes. Um I think there's a growing need right now for more doctors to be at the interface between it companies, clinical database companies and the medical and surgical environment. Not least because of the impact of A I that's coming very rapidly and very soon. So you're right. I jump ship from obstetrics into business because I had just finished my part one exams, the Royal College of Obstetricians in the 19 eighties only to be told that the government had got the manpower planning wrong. And half of half of us trainees would never get a job as a consultant. And the Royal College of Obstetricians building used to be in Regions Park next to the big mosque and next door was London Business School. So I came out of one building having done exams there and knocked on the door of London Business School and said this looks like something that I'd love to do. And I was very lucky to join a year of 100 students. And the first medic in that year, the rest were much brighter than me. It's a frightening experience when you come across a class where a third of them have p hds before they arrived, several had two P hds and they were genuinely rocket scientists. There. Many of the students, all of them engineers could do calculations in their heads that you and me would struggle to do on the calculator. It was a very important environment. So how did you start and why did you start looking at data? It was a fascinating time to be at London Business School. It was just at the time when computers had come out of universities and were suddenly on people's desks. So the first desktops were there, the first spreadsheets were around the first statistical packages that the average person could use were now available. And it was who would have thought I'd say thank you to Margaret Thatcher. But she was in government at the time and brought out a white paper that said that doctors by law should audit their work. Um As most of us know when you leave medical school, you're told to focus on the patient in front of you to the exclusion of everything else. And essentially what she was saying is you must practice medicine in the context, not just of the patient you're looking at, but all the ones you've seen, all the ones in the queue coming towards you in the context of your colleagues work and the next hospital and in fact, the whole of health care. So in other words, you really should be a half economist, half doctor to understand how to provide. As I think you've talked about this before. What is the business of healthcare? The business of healthcare is to maximize the health gain for the lowest price and by the lowest price, I don't mean the lowest quality I'm talking about getting the best value. And the only way you can do this is by having a, if you're like a management hat on your medical brain, does that make sense? Indeed, it makes sense to me and, and for the audience, I too have done an MBA and I do think and why I've introduced this topic is that we're not good as doctors thinking about it as a business. So how did you start then? Right then? Well, I came out of business school and realized that there was an opportunity to look at if you like data basing what surgeons were doing. And after a couple of years in consultancy, I stepped out and started my own company with two others. And we started putting database systems into cardiac surgery centers. I chose cardiac surgery because for several reasons, one was, you could count when an operation, when some of them have heart surgery, it sounds flippant. But a few years later I got involved with the UK, My Cars Infarction National Registry people don't neatly have their Mr in the coronary care. You can have an Mr in Tesco's or the orthopedic ward or at home. Whereas, you know, when a heart surgery has happened because you've got a room full of people, there's a chest open in the middle and you can count when the operations have happened. And the outcomes were fairly clear. Patients lived or died. If they lived, they might have a stroke or another heart attack or if you're lucky, of course, not lucky, but you would hope the majority will get home. So you could count the outcomes quite clearly and, and yet the average surgeon can't.