Building a business case for robotic surgery

By Jonathan Hatwell

You can see the future of robotic surgery — building the path to get there takes planning, buy-in, and a healthy dose of shared vision.

When you’re building a business case to invest in a robotic system, whether that’s expanding an existing program or starting a new one, there are essentially three pillars you need to consider:
Clinical benefits
for your patients
Economic benefits
for the hospital

For surgeons, it’s often about the clinical. Robotics allows them to perform various procedures with multiple benefits. They build the case from a clinical perspective by assembling evidence for those benefits and then wonder why those clinical arguments are not enough.

The challenge for hospitals, whether in a socialized system or not, is that all technology and medical developments offer clinical benefits. However, the scale of those clinical benefits and how they can benefit the system, as well as individual hospitals, can differ massively from technology to technology. 

Building the economic case

Hospitals need to be able to recoup their investment on capital equipment on a procedure-by-procedure basis over the course of its lifetime to justify the initial cost. In most systems, hospitals are reimbursed at a standard rate for a particular procedure, regardless of whether it is performed via open, laparoscopic, or robotic. Whatever technology is used needs to be funded, through reimbursement for the procedure itself, or it needs to be funded through the savings that result from the clinical benefits after the procedure. 

Access to minimally invasive procedures

The best way of thinking about robotic surgery is to really think of it as a tool to improve access to minimally invasive treatments. Minimally invasive treatments generally save time and costs during the recovery phase. For example, shorter hospital stays.

By adding a robot, you may increase the volume of procedures that can be performed using a minimally invasive technique. That increased access helps to speed up flow through the operating room, and because of faster recovery, it also helps speed up flow through the entire hospital. So, now you have economic benefits, as well as the clinical benefits of minimally invasive surgery to bring to more patients as you adopt robotics. 

Unquantifiable benefits play an important role in any business case

The unquantifiable benefits require the most work to generate a robust business case. After all, not everything is easily measured, but these benefits help shape the argument and bring it to life. Start by doing your best to quantify these benefits where possible. For example, by procuring a robot, you may make your hospital more competitive for certain procedures within a particular geography.

Retention of your team and surgical staff, as well as the cost to recruit top talent are another way to quantify these benefits. If you want to hire the best of the best you need to be able to prove that your department is moving forward with the times, or in many cases, moving ahead of the times. Access to advanced technology and a feeling of being ahead of the curve are also factors in retaining staff. Economically, by lowering staff turnover, you reduce training and recruitment costs.

"Another factor is being able to prolong and extend the working life of your surgeons due to the improved ergonomics1 of robotic surgery. This not only has great appeal to a clinician, who wants to work as long as they possibly can, but also to a hospital administrator who wants to keep those highly experienced surgeons on staff longer.”

Marketing Program Manager
Surgical Robotics Europe

Build your reputation

The reputation of your department or institution, and the impact it can have, can be a challenge to measure in clinical or economic terms, but it serves as an underlying current that runs through every aspect of your business case.

Acquiring a robotic system can support building your reputation by helping to drive press activity, and thereby attract more patients. Increasing procedure volumes or patient volumes is one way to help quantify what enhanced reputation means to an institution. 

Make case for modularity

When we think about the role of design features of a particular robot, hospitals are also well advised to think big picture about the impact on their entire surgical program. A modular design, for example, allows the hospital more flexibility in how they deploy their robotic fleet and how they optimize OR use. That increased flexibility may also help lower costs overall and contribute to a positive economic picture for the investment.

Gather buy in

To build a robust business case for something as high value as a robotic system, you must cast a wide net in terms of the reach of the potential benefits to the institution. Work with clinicians from multiple departments to capture the clinical and economic arguments from varying perspectives. The HR department is another potential ally. They can help articulate potential cost savings associated with recruitment and retention of staff and the potential benefit that acquiring advanced technology may have.

Take a long-term view

When clinician champions present the business case to hospital management, it is important to focus on intangible elements as much, if not more than, the economic and the clinical reasons. It allows leaders to see the value of a robotic system over the long run rather than year-over-year financials. That long-term mindset shifts focus to future goals, which is far more sustainable. It becomes part of the hospital’s vision statement — and part of their strategy. If you’re constantly looking at one-year time horizons as a hospital manager, you’re never going to be able to meet those long-term objectives.

Ultimately, a business case also needs to factor in support from the robotic system provider. Realizing your vision for your robotic program takes thoughtful planning and continual improvement. Look for a company that focuses on partnership and provides a 360-degree approach to your success. From a business case perspective, having a committed team by your side can be critical to bringing your vision to life. 


  1. Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018 Feb 21;153(2):e174947. doi: 10.1001/jamasurg.2017.4947. Epub 2018 Feb 21. PMID: 29282463; PMCID: PMC5838584.