There is a pattern in almost every process that stalls, and it is not price. It is this: someone in a department gets excited, asks for a quote, takes it to the board, and the process dies in a limbo where nobody said no and nobody is able to say yes.
In a hospital, "approving" is not an act. It is a sequence of people with different powers, and none of them can stand in for the others.
The six yeses
1. The department that will use it. This is not a formality: it is the one approval nothing can replace. Equipment nobody on the shift wants to use is not saved by any signature above it. It is also where the concrete case gets defined: which patients, at what moment, with what goal.
2. The department or division management. They answer for clinical practice and for one specific question: does this fit what we do, or is it one more thing for the team to do? Worth arriving here with the flow already thought through, not with a brochure.
3. Nursing management. In most departments, nursing is who will actually run the sessions. If nursing was not heard before the decision, it gets heard after, and by then it is a complaint. Their question is about time and about who does what, and there is a good answer to give.
4. IT and the data protection officer. Two roles, often two people, and the questions are almost always the same eight: network, integration, where data sits, who the controller is, updates, continuity. The answer that unblocks this fastest is being able to say the system runs on the local network and needs no integration with the hospital system.
5. Infection control. In Portuguese hospitals this is typically the GCL-PPCIRA. Equipment that touches the face of successive patients is their business, and the conversation is short if you bring a written hygiene routine rather than a promise that "it wipes down".
6. Procurement. It arrives last and everyone underestimates it. Here the question stops being clinical: it is budget cover, procedure type, single or multi-year. Worth noting that the Portuguese public procurement framework is under revision in 2026, with changes to procedure thresholds still settling: confirm the values in force with your institution's legal services rather than assuming them from memory, including ours.
The order that works
The temptation is to start at the top, because that is where the signature that seems to matter lives. In practice the path of least resistance is almost always bottom-up:
- Department: is there a concrete case and someone who wants it?
- Department management and nursing: does it fit what we already do?
- IT, data protection, infection control: in parallel, not in series. Three independent conversations that can run at once.
- Procurement and the board: with the previous three already settled in writing.
Reaching the board with the technical opinions already given transforms the decision: it stops being "should I authorise this?" and becomes "I am signing something the services have already validated".
One document per stakeholder, not a dossier for everyone
The most expensive and most avoidable mistake: sending the same thirty-page deck to six people. Each reads it looking for their question and does not find it.
What tends to work:
- department and clinical management: the use case, on one page;
- nursing: the session flow, who does what, how long;
- IT and data protection: architecture, data, controller;
- infection control: the between-patients hygiene procedure;
- procurement: the specification and the terms.
Where it stalls, and it is not ill will
- No owner. If the project does not have a name and a phone number inside the institution, it does not move. A supplier cannot be the owner.
- The informally authorised pilot. Someone lends it, someone tries it, and when it goes well nobody knows how to turn that into a contract: because there was no process. A useful pilot is agreed in writing before it starts, even when it is free.
- The right question at the wrong time. Infection control asked after the purchase is a problem. Asked before, it is ten minutes.
Where we cannot help
Bluntly: we cannot create willingness inside your institution that does not exist. If nobody in the department wants to run sessions, the project does not survive the first month, and we can hear that on a phone call. We also do not issue opinions: not on data protection, not on infection, not legal ones. We provide the technical answers so that the people who do issue them can do it quickly.
In short
- There are six yeses, and the first belongs to the department that will use it.
- Bottom-up, with the three technical ones in parallel.
- One document per stakeholder.
- No internal owner, no project, and no supplier can fill that seat.
Frequently asked questions
Who has to approve virtual reality in a hospital?
In practice there are six approvals: the department that will use it, the department or division management, nursing management, IT together with the data protection officer, infection control (in Portuguese hospitals typically the GCL-PPCIRA) and procurement. None replaces the others.
Where should you start?
With the department that will use it, not with the board. Without a concrete use case and someone willing to run it, signatures from above do not sustain the project. Conversations with IT, data protection and infection control can run in parallel, and the board should receive the decision with those opinions already given.
Does it need to integrate with the hospital IT system?
No. The system works independently and runs on the institution's local network, with no need to integrate with the existing hospital system. This is usually the answer that unblocks the conversation with IT fastest.