**2. Clinical to hospital administration collaboration**

Surgical outcomes are determined by high levels of competence of the team and optimal team working. Therefore, surgeons rely on the team. Robotic surgery is no exception, particularly as the surgeon works at a console and therefore relies on the team which includes the bedside assistant who performs important tasks at the patient bedside. Educating the robotic (or other) operating room team of nurses, anesthesia staff, and bedside assistant is crucial for patient outcome success. It is crucial that the team and team leader communicate with other staff and mentors to provide the support and guidance needed during the training stage.

Administrators and surgeons must work together to define the needs of the hospital, when developing a robotic programme. A surgeon with administrator can develop a programme which is often more patient-centric and deployable. Interestingly, robotic use can improve patient referrals, which is often the reason the administrators are supportive. The best situation is for the surgical teams and administrators to co-plan and co-deliver robotics within a hospital or strategic health partnership.

In a teaching hospital, teams generally work cohesively, allowing intellectual debate, particularly around new technologies such as robotics. They usually find funding through academic pathways or sizeable donors. This is important for training the next generation of surgeons, and improving our understanding of where robotic surgery can take us. As robotics develop in this way through research and resident training, these programmes can be delivered into more peripheral centres. Once this occurs, a close "hub-and-spoke" relationship between the teaching centre and the peripheral hospital is important if the latter wishes to improve robotic programmes and assist with the financial planning of such programmes.

Business plan and timeline development require robust data collection, concerning business planning. A reduction in length of stay with faster recovery has cost benefits as well as an increase in patient volume from increased referrals. Part of this calculation will of course be the recurring costs (disposables, instruments, maintenance) of robotics in addition to the capital outlay. As with any negotiation, one should show non-clinical administrators that robotics will benefit patient care and improve hospital income, plus reputation.
