Getting Oriented — Who’s in the Room?

• Tell us your name, role, and the one outcome you personally want from exploring robotic surgery
• Which stakeholders will be actively involved in evaluation and decision-making for this initiative? Options: CEO/President, CFO/Finance, CMO/Chief Medical Officer, Chief of Surgery, Surgical Service Line VP/Director, OR Manager, Procurement/Purchasing, Risk/Compliance, Other
• Who would you point to as your internal surgeon champions or early adopters for a robotic program?
• What is the single most important evaluation criterion that will determine whether you proceed? Options: Clinical outcomes & evidence, Total cost of ownership, Surgeon adoption/readiness, System reliability & uptime, Training and support, OR integration footprint, Procurement flexibility (lease/purchase/usage)
• How soon do you expect to reach an initial decision (e.g., approve pilot, sign contract)? Options: Immediately/Days, Within 1–3 months, 3–6 months, 6–12 months, 12+ months, No defined timeline

Why Now? The Real Cost of Standing Still

• If you choose not to invest in a robotic program over the next 12–24 months, what is the single biggest operational or strategic risk you foresee?
• How much of your caseload or referral leakage is currently influenced by surgeon preference or by competing hospitals offering robotics? Options: Majority (>50%), Significant (25–50%), Some (10–25%), Minimal (<10%), Unknown
• Have you lost—or failed to recruit—surgeons because of lack of robotic capability? If yes, describe briefly. Options: Yes, multiple, Yes, one or two, No, Unsure
• How would you quantify the financial impact today from longer LOS, readmissions, or case cancellations that you believe robotics could influence? (provide estimate or example case)
• Which external pressures are pushing this project forward? (select all that apply) Options: Market competition, Surgeon recruitment/retention, Patient demand, Payer incentives/value-based care, System strategic plan, Regulatory/quality targets

What’s Getting in the Way? Tell Us What’s Frustrating You

• What current OR or perioperative problems do you tolerate that you’d rather stop accepting?
• How often do scheduling conflicts or platform availability cause case delays or cancellations on average per month? Options: >10, 5–10, 1–4, Rarely/0, Unknown
• Describe a recent case where limitations of your current approach (laparoscopy/open) led to an avoidable outcome or lost opportunity.
• Which recurring cost feels most painful right now—capital depreciation, per-procedure consumables, maintenance, or staffing—and why? Options: Capital depreciation, Consumables/instrument costs, Service & maintenance, Proctoring/training costs, OR staffing overtime, Other
• How does the clinical team emotionally respond to current constraints—frustration, resignation, urgency, or optimism? Options: Frustration, Resignation, Urgency, Optimism, Mixed

Who Wields the Real Power? Mapping Influence and Vetoes

• If one person could veto this project, who would that be and what would their main objection likely be?
• How aligned are your executive, finance, and clinical leaders today—fully aligned, somewhat aligned, or fragmented? Options: Fully aligned, Somewhat aligned, Fragmented/competing priorities, Unclear
• What procurement or capital approval steps must occur before purchase or lease can be signed? Please list the gates and typical timeframes.
• Which features or capabilities do your surgeons insist on from a platform? (select all that apply) Options: Specific instrument articulation, Console ergonomics, Energy integration, 3D visualization, Multi-quadrant reach, Cross-specialty versatility
• Are there internal politics or specialty competition that could slow adoption, and how have you navigated similar tensions before?

Outcomes That Change Minds — What Would Convince You?

• If you could pick one metric that, when improved, would justify expansion of the program, what would it be? Options: Case volume growth, Length of stay reduction, Readmission reduction, OR minutes saved per case, Margin per case (net), Surgeon recruitment/retention
• Please provide your current baseline for 2–3 priority metrics (e.g., average LOS for colorectal, readmission rate for urology, OR turnover minutes).
• What is your target improvement for those metrics within 12 months of deployment? Options: >30% improvement, 15–30% improvement, 5–15% improvement, Maintain with other gains, Not defined
• What type of clinical or economic evidence do you need to feel comfortable—randomized trial data, real-world registry outcomes, peer references, or an on-site pilot? Options: Randomized controlled trials, Large registry/real-world data, Peer hospital references, Local proctored pilot (first-case outcomes), Health-economic model/ROI analysis
• Who in your organization will own measurement of success post-deployment (e.g., quality, finance, surgical service line)? Options: Quality/Clinical Outcomes, Finance/CFO office, Surgical Service Line leadership, OR Operations/Manager, Other

A Day in the OR After Adoption — Practical Workflow Questions

• Imagine your first week using the system—what would have to go right for your team to feel confident after 5 cases?
• Which specialties will share the system and what percentage of OR time do you expect each to use initially?
• How many proctored cases and what level of simulation training do your surgeons and OR staff expect before independent use? Options: 1–3 proctored cases, 4–8 proctored cases, >8 proctored cases, Simulation-only then proctor as needed, Undecided
• What OR footprint or infrastructure constraints should we plan for (e.g., ceiling height, door widths, power, integrated imaging)?
• How do you currently manage instrument sterilization and turnover, and what concerns do you have about introducing new disposable or reusable instruments?

Money Conversations — What Terms Make or Break the Deal?

• Which commercial acquisition model would your finance team prefer in principle: purchase, capital lease, operating lease, or per-case/usage pricing? Options: Purchase (CAPEX), Capital lease, Operating lease/OPEX, Per-case/usage model, Blended/other
• What is your acceptable range for per-procedure incremental cost (consumables + service) to maintain margin targets? Options: <$500, $500–$1,000, $1,000–$2,000, >$2,000, Not defined
• Which SLA or uptime commitments are mandatory for you to consider a supplier? (select all that apply) Options: 99% scheduled uptime, Guaranteed response time for service, Loaner system during downtime, Local parts inventory, Regular preventive maintenance windows
• What financial approvals or thresholds (board, capital committee) will be required to move forward, and what is the typical approval lead time?
• Is there a total cost of ownership model or templates you would like us to populate for your finance team? If yes, which scenarios (purchase/lease/usage)? Options: Purchase model, Lease model, Usage-based model, All the above, Not needed

Evidence, Safety, and Comfort — What Would Let You Sleep at Night?

• What single safety or regulatory concern would cause you to pause deployment, and how could a vendor mitigate it?
• Which types of peer references or site visits would be most persuasive—same-size community hospital, academic center, or regional health system? Options: Same-size community hospital, Academic medical center, Large regional health system, Centers of excellence only, Any of the above
• Do you require specific indemnity, warranty, or data-protection language in contracts? If so, please highlight the must-haves.
• How important is local clinical proctoring versus remote mentoring during the ramp phase? Options: Local proctoring essential, Prefer mix of local + remote, Remote mentoring sufficient, Undecided
• Would participation in a registry or shared outcomes program be acceptable, and what reporting cadence would you expect? Options: Yes—mandatory, Yes—optional, No, Undecided

Implementation Readiness — What Will Stop or Speed Deployment?

• What internal resources (project manager, OR champion, IT lead) can you commit to a deployment timeline, and how many hours per week can they dedicate?
• What site-prep items are already a known constraint (space, imaging integration, network, sterile processing), and which are unresolved?
• Which milestone would make you comfortable moving from pilot to full deployment—days of uptime, case mix proven, ROI threshold, or surgeon adoption rate? Options: Uptime & reliability proven, Target case mix achieved, Projected ROI met, Surgeon adoption threshold reached, Combination
• If we proposed a staged pilot, what scope feels manageable—single specialty, multi-specialty share, or target high-volume procedure? Options: Single specialty pilot, Multi-specialty shared use, High-volume procedure pilot, Comprehensive go-live
• Who will be the single point of contact from your side for scheduling, escalation, and acceptance sign-offs?

Final Check — Commitments, Timeline, and Next Steps

• If everything aligned perfectly, when would you want the first proctored case to occur? Options: Within 30 days, 30–90 days, 3–6 months, 6–12 months, No timeline yet
• What are the non-negotiable decision criteria we must help you demonstrate to secure internal approval?
• Who needs to be present at the next meeting to make progress, and what would success look like for that meeting?
• What concerns would you still like us to address before you can take this to your capital/leadership committee?
• Would you like a tailored ROI and clinical-evidence packet built for your site (includes cost model, expected outcomes, and peer references)? Options: Yes — build full packet, Yes — build high-level summary, Maybe — need more info, No

Getting Started — A Quick Snapshot

• To get us oriented, please share your hospital or system name, the best contact for clinical/surgical questions, and your role
• Which facility(ies) and OR suites would this evaluation cover? Options: Single hospital, Multi-hospital system, Ambulatory surgery center(s), Hybrid (hospital + ASC)
• Approximately how many total OR cases does the facility perform per year? Options: < 2,000, 2,000–5,000, 5,001–10,000, 10,001–20,000, > 20,000
• Roughly how many robot-assisted cases did you perform last year (all platforms combined)? Options: 0, 1–100, 101–300, 301–700, 701+
• Which specialties currently use robotic assistance at your institution? Options: Urology, Gynecology, General/Colorectal, Thoracic, Head & Neck, Orthopedics, Other, None

Are Your Numbers Telling the Whole Story?

• When you look at last 12 months of surgical volumes, what trend surprised you or challenged your assumptions?
• Break down your current annual case volume by specialty (if known) — share best estimates or ranges Options: Urology: <100 / 100–300 / 301–600 / 601+, Gynecology: <100 / 100–300 / 301–600 / 601+, General/Colorectal: <100 / 100–300 / 301–600 / 601+, Thoracic: <50 / 50–200 / 201+
• How concentrated are your robotic cases among surgeons—do a handful of surgeons perform most cases? Options: Top 1–2 surgeons do >70%, Top 3–5 surgeons do 50–70%, Distributed evenly across many surgeons, No robotic cases currently
• How fast is your relevant surgical volume trending year-over-year for target specialties? Options: Declining, Flat, Growing 1–5%/yr, Growing 6–15%/yr, Growing >15%/yr
• Which procedure types do you expect to grow most over the next 12–24 months and why?

Who's Actually Driving Decisions in the Room?

• If a go/no-go decision were needed tomorrow, who would effectively control the outcome—and who often influences them behind the scenes?
• Which of these stakeholders are actively engaged today in robotic strategy conversations? Options: CEO, CFO, CMO, Chief Nursing Officer, VP of Surgical Services, Chief of Surgery, Perioperative Director, Procurement, Surgeon Champions
• Who are your named surgeon champions (if any), and how many cases does each typically perform per month?
• How aligned are clinical and financial stakeholders on the value case for robotics right now? Options: Strongly aligned, Some alignment but gaps, Mostly misaligned, No alignment / separate views
• Where do you sense the highest risk of derailment in internal decision-making—culture, budget, evidence, OR logistics, or surgeon preference? Options: Culture/leadership, Budget/capital, Clinical evidence, OR scheduling/logistics, Surgeon platform preference, Other

Is Your OR Schedule Built for Robotics—or Working Against It?

• How often does lack of OR availability or scheduling complexity limit the ability to book robotic cases when a surgeon requests it? Options: Almost always, Often, Sometimes, Rarely, Never
• What is your average OR utilization rate during peak weekday hours? Options: <60%, 60–70%, 71–80%, 81–90%, >90%
• Typical turnover time between cases in rooms where robotics runs (estimate): Options: <20 minutes, 20–30 minutes, 31–45 minutes, >45 minutes
• Do you run cross-specialty robotic scheduling on the same systems (e.g., urology in morning, gyn in afternoon)? If yes, how often does that create conflicts? Options: Yes — daily conflicts, Yes — occasional conflicts, Yes — rarely, No cross-specialty scheduling
• Describe any creative scheduling or block strategies you use today (floating block, shared block, first-case prioritization, etc.)

When You Crunch the Numbers, What Keeps You Up at Night?

• What is the single largest financial concern about expanding or acquiring robotic capability at your institution? Options: Capital cost, Per-case consumable costs, Service/maintenance expense, Uncertain reimbursement, Insufficient ROI timeline
• What is your current approximate average variable cost per robotic case (instruments/consumables only)? Options: <$500, $500–$1,000, $1,001–$2,000, >$2,000, Unknown
• How much capital is currently available or budgeted for surgical robotics in the next 12–24 months? Options: No capital identified, < $500k, $500k–$2M, $2M–$5M, >$5M
• What payor or case-mix factors most affect your expected margin on robotic cases (Medicare mix, commercial rates, high-deductible populations, bundled payments, etc.)? Options: High Medicare/Medicaid mix, Commercial-dominant, Bundled payment contracts, Mixed / unpredictable, Other
• How long of a payback/ROI window would leadership consider acceptable for a platform acquisition (years)? Options: <1 year, 1–3 years, 3–5 years, 5–7 years, Unsure

How Confident Are You in Your Clinical Outcomes Data?

• How certain are you that your current data accurately reflects outcomes for robotic versus non-robotic procedures? Options: Very certain, Somewhat certain, Uncertain, We lack comparative data
• Which outcome metrics do you currently track that would matter for a robotic value case? Options: Length of stay, Readmission rate, Complication rate, Conversion to open, Time-to-discharge, OR time per case, Patient satisfaction/NPS
• Where is that data stored and how accessible is it for analysis? Options: EHR / EMR reports, Clinical registry, Third-party analytics, Manual spreadsheets, Not tracked centrally
• Tell us about a specific clinical outcome you’d like to improve and why it matters to leadership (e.g., reduce LOS by X days for colorectal cases)
• Have you published or participated in outcome registries or peer-reviewed analyses related to robotics? If so, summarize briefly. Options: Yes — internal registry, Yes — national registry, Yes — peer-reviewed publication, No

Are Surgeons Loving This—or Just Tolerating It?

• If surgeon sentiment were a net promoter score, would it be driving adoption or holding it back? Options: Strong promoter — driving adoption, Mildly positive, Neutral, Mildly negative, Actively resisting
• Which robotic platforms do your surgeons prefer today, and why?
• How many surgeons are credentialed and independent on robotic cases per specialty? Options: 0, 1–2, 3–5, 6–10, 10+
• What are the biggest surgeon-level barriers to choosing robotics for a case (comfort, OR time, compensation, evidence, preferred instruments)? Options: Comfort/skill, Longer OR time, Compensation model, Lack of evidence, Platform preference, Other
• Describe a recent surgeon conversation that revealed a hidden objection or a surprising advocacy moment

What's Really Eating Up Consumables and Time?

• How confident are you that your instrument and consumable inventory data reflect actual utilization and waste? Options: Very confident, Somewhat confident, Low confidence, We don’t track utilization
• Which procurement or inventory methods do you use for robotic instruments today? Options: Vendor-managed inventory, In-house stockroom, Consignment, Per-case ordering, Other
• How often do you experience stockouts, expired instruments, or last-minute reorders for robotic cases? Options: Weekly, Monthly, Quarterly, Rarely, Never
• Estimate the percentage of instrument cost that could be reduced through better reprocessing, reuse, or alternative purchasing models Options: 0–10%, 11–25%, 26–40%, 41–60%, Unknown
• Are there opportunity areas in consumables management you’ve already started to address (pilot reuse, tracking tech, alternative vendors)? Options: Yes — multiple pilots, Yes — planning stage, No, not yet, Not allowed by policy

Is Your Tech Stack Ready to Plug In?

• How would you rate your IT/biomed readiness to integrate a new surgical system (connectivity, network bandwidth, imaging, middleware)? Options: Fully ready, Mostly ready with minor work, Significant work required, Not sure / need assessment
• Which integrations are required or desired for the platform (EMR, PACS, video capture, SSO, scheduling system)? Options: EMR/EPIC/Cerner integration, PACS/DICOM, OR scheduling system, Video capture/recording, Active Directory/SSO, None
• Do you have OR footprint constraints (room dimensions, ceiling height, power/UPS capacity) that we should know about? Options: Yes — constraints exist, No — rooms flexible, Unsure / need site survey
• Who owns clinical/technical integration decisions (IT director, biomedical engineer, OR manager)? Options: IT Director, Biomedical Engineering, Periop/OR Director, Clinical Informatics, Other
• Are there cybersecurity or data privacy requirements (local policy, system isolation, vendor security assessment) that will affect deployment? Options: Yes — strict requirements, Some requirements, No special requirements, Unsure

Training, Competency, and Proctoring — Where Do You Stand?

• How prepared is your surgical team for adopting new robotic workflows (surgeon, scrub techs, anesthesia, nursing)? Options: Highly prepared, Some prepared with gaps, Minimal preparedness, Not prepared
• What training models do you prefer or require (simulation, proctored cases, vendor courses, in-house credentialing)? Options: Simulation lab, Proctored OR cases, Vendor-led training, In-house training program, Hybrid
• How many proctored cases would each surgeon typically need before independent credentialing at your center? Options: 0–2, 3–5, 6–10, 10+
• Do you have an existing OR educator or competency program to sustain training beyond go-live? Options: Yes — dedicated educator, Yes — shared resource, Planning stage, No
• What would make your surgical teams feel safe and confident during early adoption (metrics, milestones, support hours, onsite proctors)?

Regulatory, Compliance and Risk — Anything Hiding Below the Surface?

• Are there any pending regulatory, legal, or compliance issues that could affect procurement or clinical use of a robotic system? Options: Yes — known issues, Possibly — under review, No, Unsure
• Does your facility require local clinical committee review or special approvals for new surgical technologies? Options: Yes — multiple committees, Single committee review, No additional approvals, Unsure
• Do you have specific liability, vendor indemnification, or credentialing requirements for new devices? Options: Yes — strict, Moderate, Minimal, Unsure
• How do you prefer to document clinical acceptance criteria and go/no-go checkpoints (committee sign-off, pilot metrics, formal acceptance test)? Options: Committee sign-off, Pilot metrics with thresholds, Proctor/first-case sign-off, Other
• Are infection control or sterilization policies likely to affect instrument reprocessing or single-use consumable choices? Options: Yes — strict policies, Some constraints, No significant constraints, Unsure

If We Could Snap Our Fingers, What Would Change in 6 Months?

• What's the single most important measurable improvement you'd want to see within 6 months of deployment? Options: Increased case volume, Reduced LOS, Lower complication rate, Improved OR throughput, Surgeon adoption
• Name the top three outcome or operational KPIs leadership will use to judge success
• How aggressive is your desired timeline from decision to first proctored case? Options: <3 months, 3–6 months, 6–12 months, 12+ months, Unsure
• What short-term barriers would need to be removed to make that timeline realistic (capital approval, OR modifications, training slots, surgeon availability)?
• If we demonstrated a credible plan to hit your 6-month KPI, how would that change internal support? Options: Immediate executive support, Conditional support, Little change, Unsure

Start with the People Who Will Make It Happen

• Who from your hospital will be actively involved in evaluating and approving a robotic surgery investment? Options: CEO/President, Surgical Service Line VP/Director, Chief of Surgery, Chief Medical Officer, Chief Nursing Officer, Finance/CFO, Procurement/Purchasing, OR Manager/Director, IT/Clinical Engineering, Other
• Which single person or role is most likely to hold final sign-off authority for capital or contract approval? Options: CEO/President, CFO, Surgical Service Line VP/Director, Board/Investment Committee, Chief of Surgery, Other
• How would you describe the current sentiment among your surgeons about adopting a new robotic platform? Options: Very enthusiastic - ready to champion, Cautiously interested - need evidence, Neutral - will follow volume/leadership, Resistant - prefer existing platforms, Mixed strongly by specialty
• Tell us about any surgeon champions or early adopters—who are they, which specialties, and what have they already said or done?
• How aligned are your clinical leaders and executive leadership on the strategic priority of robotic surgery right now? Options: Fully aligned, Mostly aligned with some gaps, Misaligned on priorities, Unclear / no conversation yet

Are We Solving The Right Problem?

• If nothing changes in the next 12–24 months, what single outcome would hurt your surgical program the most (volume loss, recruitment, margins, reputation, etc.)? Options: Loss of referral volume, Inability to recruit/retain surgeons, Declining margins per case, Operational bottlenecks in OR schedule, Competitive disadvantage vs. local systems, Other
• Which of these is currently the primary driver behind considering a robotic investment? Options: Clinical outcomes improvement, Surgeon recruitment/retention, Market competitiveness/branding, Case mix growth / revenue, OR efficiency / turnover reduction, Regulatory or quality imperatives, Other
• How long has this driver been a priority for your team, and how has urgency changed over time? Options: New priority (<6 months), Surfaced in the last year, Ongoing for 1–3 years, Multi-year strategic priority (>3 years)
• Who internally argues most strongly against moving forward, and what are their core concerns? Options: Cost/ROI skepticism, Surgeon preference for other platforms, OR logistics/space concerns, IT/integration risk, Staffing and training burden, No strong internal opposition
• What would happen to patient referrals, surgeon hiring, or service line reputation if you delayed a decision another year?

What’s Actually Happening in Your ORs Today?

• Where is your OR throughput or case mix leaking clinical or financial value today? Options: Excessive turnover time between cases, Cancellations due to equipment/availability, Low utilization of specialty-capable rooms, Surgeon scheduling conflicts across specialties, High conversion-to-open rates or complications, Other
• Please list current annual case volumes by specialty you expect to use the robot (urology, gyn, colorectal, general, thoracic, ENT, other).
• Which robotic or minimally invasive platforms are in regular use today, and what average uptime or availability do you experience with them? Options: No existing robotic platform, Single-vendor robotic platform, Multiple platforms (mixed vendors), Laparoscopy only, Other
• Which surgeons or specialties are most likely to adopt a new system immediately, and who will need the most convincing? Options: Urology, Gynecology, General/Colorectal, Thoracic, ENT/Head & Neck, Pediatrics, Other
• What specific workflow or OR staffing constraints regularly limit your ability to add robotic cases (e.g., anesthesiology coverage, scrub tech experience, room footprint)?
• How often do instrument or consumable shortages, service outages, or software issues cause case delay or cancellation? Options: Regularly (weekly/monthly), Occasionally (quarterly), Rarely (annual), Never / not tracked

What Keeps You Up at Night About Cost and Economics?

• Is per-procedure consumable and service cost currently the biggest unknown in your ROI model? Options: Yes — largest unknown, One of several significant unknowns, Not a primary concern, Unsure
• Which acquisition model does your finance team prefer or have policy for? Options: Capital purchase, Operating lease, Per-use/consumable-based usage model, Hybrid (purchase + usage), Undecided / No policy
• What is your acceptable payback period or ROI threshold for a capital investment of this magnitude? Options: <2 years, 2–4 years, 4–6 years, >6 years, Not yet defined
• How do you currently account for indirect benefits—referral growth, reduced LOS, surgeon recruitment—when evaluating new technology? Options: Included in formal ROI model, Discussed qualitatively, Not included but would like to, Not considered
• What are your top three cost concerns we should model explicitly (e.g., instrument life/repurchase rate, service SLA premiums, consumable pricing volatility)? Options: Instrument replacement frequency, Per-case disposables/consumables, Service contract uptime guarantees, Training/proctoring costs, Downtime impact on revenue, Other

Imagine Clinical Wins That Change the Board’s Mind

• What specific clinical or financial outcomes would convince leadership this investment was essential (e.g., X% reduction in LOS, Y% case mix growth, Z% margin improvement)?
• Which single metric matters most to your board or executive team when approving capital: cost savings, revenue growth, patient outcomes, market share, or surgeon recruitment? Options: Cost savings / margin, Revenue / case volume growth, Patient outcomes / quality metrics, Market competitive positioning, Surgeon recruitment/retention
• What level of clinical evidence or published outcomes does your committee require before committing to a new system (single-center case series, multicenter RCTs, registry data, peer site visits)? Options: Peer site visits with proctored cases, Multicenter registry data, Randomized controlled trials, Published specialty-specific outcomes, Internal pilot results, Other
• Over what timeline would you expect to see measurable clinical improvements after deployment (first 3 months, 6 months, 12 months)? Options: First 3 months, 3–6 months, 6–12 months, 12+ months
• Who needs to be shown these early wins (which stakeholders, committees, or external partners) to secure long-term program support? Options: Board/Investment Committee, CEO/C-Suite, Surgical Service Line Leadership, Physician Steering Committee, Payors / Payers relations, Other

What Would It Take to Make Deployment Seamless?

• If we promised to minimize OR disruption during installation, what specific concerns would you still want addressed up front? Options: Space/footprint constraints, Electrical/medical gas requirements, IT/Cybersecurity integration, Sterile processing and instrument handling, Staff scheduling for proctoring, Other
• Describe your OR footprint and where you would expect the robot to live—shared across specialties, dedicated room, or mobile between ORs? Options: Hybrid arrangement, Dedicated robotic OR, Shared robotic room across specialties, Mobile system moved between ORs
• Which IT integrations are mandatory for go-live (e.g., EMR case scheduling, device network, imaging integration, PACS, single sign-on)? Options: EMR/CPOE scheduling, PACS/image overlay, OR middleware/room control, Device network / telemetry, Single sign-on / user provisioning, None required
• What internal approvals or regulatory checks must be completed before equipment installation (biomed sign-off, infection control, hospital safety committee, state approvals)? Options: Biomedical Engineering approval, Infection Control clearance, Facilities/Engineering sign-off, Safety/Compliance Committee, State/Regional regulatory filings, None / not sure
• How would you ideally schedule proctored first cases—intensive consecutive days, spaced weekly, or mixed—and who would you expect to attend from your side? Options: Consecutive days (block schedule), Spaced weekly sessions, Single proctored cases per surgeon, Hybrid approach

Who Will Own Success After We Leave?

• Who will be accountable for clinical governance and ongoing credentialing of robotic surgeons at your hospital? Options: Chief of Surgery, Surgical Service Line Director, Medical Staff Office, A multidisciplinary credentialing committee, Other
• Which team will manage instrument inventory, consumables ordering, and cost tracking for robotic cases? Options: Supply Chain/Materials Management, OR Manager/Coordinator, Central Sterile/Sterile Processing, Clinical Engineering, Shared responsibility
• How do you prefer surgeon and OR team training to be delivered initially (simulation + classroom, simulation + proctored live cases, entirely on-site proctoring, remote proctoring support)? Options: Simulation + proctored live cases, Simulation + classroom training, On-site proctoring only, Remote proctoring + simulation, Blended approach
• What ongoing competency measures or acceptance criteria would you expect before unaided surgeons start independent robotic cases? Options: Number of proctored cases, Simulation performance benchmarks, Peer review of first cases, Formal credentialing exam, Combination of the above
• How should service escalation and uptime accountability be structured (24/7 phone support, guaranteed on-site SLA, swap unit availability, remote diagnostics)? Options: 24/7 phone + remote diagnostics, Guaranteed on-site visit within X hours, Swap/loaner unit available, Tiered SLA based on criticality, Other

Let’s Agree What Would Make This Impossible to Walk Away From

• What is the single decision milestone (budget window, board approval, surgeon commitment) that would commit you to move forward? Options: Board/Investment Committee approval, Allocated capital in current fiscal year, Signed surgeon/clinical champions, Signed preliminary commercial term sheet, Other
• Realistically, what is your target timeline for making a decision and achieving first-case proctoring (decision in X months → first case in Y months)? Options: Decision <3 months / first case 3–6 months, Decision 3–6 months / first case 6–9 months, Decision 6–12 months / first case 9–15 months, Longer / TBD
• What pilot or proof-of-value would you accept before committing (single-site pilot, specialty-specific pilot, phased deployment, financial guarantee)? Options: Single-site clinical pilot, Specialty-focused pilot, Phased deployment across specialties, Performance or financial guarantee, No pilot — full deployment desired
• Who else needs to be engaged or brought into the conversation before we can finalize next steps (internal or external stakeholders)? Options: Board/Investment Committee, Finance/CFO, Hospital Legal/Contracts, Supply Chain, Regional health system leadership, Surgeon champions, Other
• What must we deliver in our next meeting to make you feel confident about proceeding (detailed ROI model, peer site visit, pilot plan, contract template, regulatory checklist)? Options: Detailed ROI and sensitivity analysis, Peer site visit with surgeon peers, Pilot implementation plan and timeline, Draft commercial terms and SLAs, Regulatory and compliance checklist

Getting Comfortable — quick introductions to set the context

• Who are you and what will you personally be responsible for in evaluating surgical robotics?
• Which best describes your organization? Options: Independent community hospital, Regional health system, Academic medical center, Ambulatory surgery center (ASC), Other
• What timeline are you working toward for a decision about a robotic platform? Options: Already decided (contracting), 0–3 months, 3–6 months, 6–12 months, 12+ months, Undecided
• Who else on your team should we be talking to as part of discovery (roles/titles)?
• Which of these outcomes is the single most important driver for this evaluation right now? Options: Clinical outcomes (complications, readmissions), Surgeon recruitment/retention, OR efficiency and throughput, Competitive positioning/market share, Total cost of ownership, Other

If We Keep Doing What We’re Doing, Who's Going to Lose Sleep?

• What would you say keeps leadership up at night about your current surgical capability?
• How have recent clinical outcomes, patient satisfaction scores, or referral patterns shifted because of current capabilities? Options: Improved, No change, Declined, Not tracked
• Can you share a recent example where limited surgical capabilities or delays directly impacted a patient, referral, or hospital reputation?
• How do your surgeons feel about the current technology—energized, indifferent, frustrated, or something else? Options: Excited/advocates, Open but cautious, Resistant, Divided strongly, Indifferent
• If nothing changes in the next 24 months, what are the top three risks you anticipate (clinical, financial, operational, competitive)?

How Is the OR Really Operating Today — a candid look at volumes and utilization

• What is your annual case volume by specialty for the procedures you expect to run on a robotic platform (list specialties and volumes)?
• How many ORs are dedicated to minimally invasive/robotic-capable cases, and how often are they occupied during peak hours? Options: 1–2 ORs, 3–4 ORs, 5+ ORs, No dedicated ORs
• What percentage of eligible cases are currently performed robotically vs. laparoscopically or open (estimate by specialty)? Options: 0–10%, 10–30%, 30–60%, 60–90%, 90–100%, Not tracked
• Which platforms are your surgeons currently using or prefer, and why (brand, key reasons)?
• How often do ORs experience turnover delays, cancellations, or equipment-related downtime that affect scheduling? Options: Daily, Weekly, Monthly, Rarely, Unknown
• Describe any existing bottlenecks you see when trying to scale specialty case volume (examples: staffing, scheduling, instrumentation, sterile processing).

The Hard Numbers That Decide Whether This Makes Sense

• What financial target are you implicitly or explicitly using to justify a robotics investment (ROI timeline, payback period, or NPV expectation)? Options: <12 months, 12–24 months, 24–36 months, 36+ months, Not defined
• What is your average contribution margin or net margin on the procedures you expect to move to robotics (or the closest proxy)?
• How much does the organization currently spend on instruments/consumables per procedure for these specialties (ballpark)? Options: <$500, $500–$1,000, $1,000–$2,000, >$2,000, Unknown
• Which acquisition model would be most acceptable to leadership—purchase, capital lease, OPEX lease, or per-case usage—and why? Options: Purchase, Capital lease, OPEX lease, Per-case usage, Undecided
• Are there internal budget windows, fiscal constraints, or grant/timing considerations that would make or break the deal?
• If a vendor could guarantee specific financial or throughput metrics, which single metric would change your decision the most? Options: Case volume growth, Net contribution per case, OR minutes saved per procedure, Reduced LOS/readmissions, Surgeon onboarding speed

Surgeon Adoption — who will lead, who will resist, and what they need

• Which surgeons are your early champions for robotics and what motivates their advocacy (clinical outcomes, ergonomics, recruitment)?
• Who on the surgical staff is most likely to resist adoption, and what are their main concerns?
• What prior experiences—positive or negative—have your surgeons had with vendor training, proctoring, or credentialing that shape their expectations now?
• How quickly do you need surgeons and OR teams to be independently competent and credentialed after system delivery? Options: <2 weeks, 2–6 weeks, 6–12 weeks, 3+ months, No timeline set
• Which training formats would accelerate adoption for your team (simulation, proctored cases, on-site bootcamps, remote mentoring)? Options: Simulation + hands-on, On-site proctoring, Virtual/remote mentoring, Blended program, Other
• Describe any non-technical adoption barriers we should be aware of (compensation models, call schedules, OR politics, supply chain habits).

What Would Winning Actually Look Like — define the moment we can celebrate

• If this program is an undisputed success in 12 months, what three measurable outcomes will prove it?
• Which of the following success signals do you weigh most heavily? Options: Case mix expansion, OR minutes saved, Reduced length of stay, Lower complication/readmission rates, Surgeon satisfaction/recruitment, Consumable cost neutrality
• What baseline data do you currently have that we can use for before/after comparisons (e.g., LOS, readmit rate, OR minutes, case volumes)? Options: Complete dataset, Partial dataset, Anecdotal only, None
• By what date would you expect to see meaningful early signals (first-case outcomes, OR efficiency) after go-live? Options: First 30 days, 30–90 days, 90–180 days, 6+ months
• What would be an acceptable margin of improvement (percentage) on your top clinical or financial metric to consider this initiative successful?

Hidden Risks and Deal-Breakers — the blunt conversation most skip

• What non-negotiables would immediately halt a purchase (e.g., uptime SLA, sterilization workflow, single-vendor dependency)?
• How much system uptime and response time from service is minimum acceptable to your team? Options: 99.9% / next-business-hour, 99.5% / 4-hour response, 99% / same-day, Below 99% acceptable, Unsure
• Are there IT, cybersecurity, or EMR-integration constraints or approval gates we need to plan for? Options: Yes—formal approvals, Informal review only, No constraints, Unsure
• Do you have supply-chain or sterilization capacity concerns that could limit instrument turn-around or case volume? Options: Yes—capacity constrained, Near capacity, Sufficient capacity, Unsure
• What regulatory, union, or credentialing hurdles have historically delayed similar technology rollouts here?
• If there was one unknown risk you’d want a vendor to guarantee against, what would it be?

The Decision Journey — map the path, milestones, and who signs off

• Who are the formal decision-makers and approvers for capital or contract sign-off (name/role and approval threshold)?
• What are the top three evaluation criteria the procurement or value-analysis committee will use?
• Do you require external evidence (peer-reviewed studies, site visits, published registries) and, if so, which types carry the most weight? Options: Peer-reviewed RCTs, Registry data, Peer site visits, Vendor-led outcomes studies, Health-economics models
• What procurement steps, internal reviews, or committee meetings are on the calendar that will influence timing?
• If we were to propose a pilot or limited deployment, what would a minimally acceptable pilot look like (number of cases, specialties, timeline)?
• What would you like us to deliver next to help you advance this with stakeholders (ROI model, site visit, surgeon-to-surgeon call, draft commercial term sheet)? Options: ROI model, Site visit reference, Surgeon peer call, Draft term sheet, Technical/IT spec sheet, Other