Customer Discovery 120+ Interviews

Summer 2020

CONFIDENTIAL Use of material without permission strictly prohibited. Table of Contents

1. Key Needs

Part 1 2. Competitor Analysis 3. Hubly Analysis Click to go to 4. Purchasing Pathway each section Part 2 5. Marketing Strategy 6. Hubly Marketing 7. Appendix Customer Discovery Part 1 Overview

Using “Three Why’s” we analyzed competitors and Hubly’s technology with key surgeon needs to create a value proposition

Why buy anything? Why buy Hubly? Why buy now?

Understanding the priorities and Using the six key needs and We ideated marketing leverage needs of surgeons helped inform background research we analyzed points that address unmet needs with us on ways to answer why they Hubly and its competitors on how current drills that would motivate buy new drills well they address surgeon needs surgeons to “buy now”

Part 1 Overview | Key Needs | Competitors | Hubly Key Needs Key Needs Interviews

We employed the following methodology to identify surgeon preferences and, ultimately, our key needs for drills

Buying Process • How much of a say do surgeons have in buying drills? • How often are new drills bought? Hospital Physicians (62) Residents (15) Administrators (14) • How do surgeons get information on new Click to edit Master subtitle style drills? Current Drills • What drills have you used? • What qualities do you look for in drills? • What specific qualities do you look for in single use drills?

Technological Features • What new technologies are needed? • Would you like plunge prevention and finer control? • How important is catheter guidance • technology? Key Needs Overview

Research and interviews have elucidated six key needs surgeons have when considering surgical drills

Ergonomics

Pricing Longevity

Technology Features Temperature Control

Compatibility Part 1 Overview | Key Needs | Competitors | Hubly Ergonomics

Hubly can differentiate themselves by addressing the following surgeon-focused, ergonomic considerations 1,2,3,4,5 Specific Features Qualities Characteristics Lighter Design Foot pedal Surgeons prefer lighter and more Flexibility Foot pedals still have a lot of undesirable Surgeons prefer drills that have more sensitive drills, which factor into a qualities, including ‘clunkiness’ prominent ergonomic concern: flexibility in terms of direction stress on hands. “With Anspach, the foot pedal is too It is difficult to perform acute angles with small, making it hard to get into really thick Drills feel big and bulky due to the size of drills skulls. Seems ridiculous but it’s true! the handpiece In the Stryker 6/7 drills, the drill bit Lightweight drills also have lighter attachment prevents the drill hand from ‘I have noticed a difference across different touches that translate to more sensitivity going left to right manufacturers in terms of the number of Larger drills create more stress and durotomies based on the drills/foot plates” Reliability strain on the hands, especially among Reliability was stated as a highly orthopedic surgeons -Neurosurgeon, Emory desirable feature across majority of Noise Control interviews Cordless Drills have issues with frequent stopping Although not a priority, surgeons and starting, especially with burr hole Surgeons prefer cordless drills, although prefer drills that are less noisy procedures. battery life remains a concern Although sound is used to indicate Cordless-ness translates to greater mobility “The success of the procedure is mostly breaching the bone in some drills, lots of Large cords look more like hoses and can be predicated on reliable but not exceptional wiggle and chatter is irritating. hazards for tripping drill performance” -Neurosurgeon, UW

Part 1 Overview | Key Needs | Competitors | Hubly Longevity

Surgeons prefer durable, easily reparable, and electric or pneumatic drills as they tend to last longer 6,7,8,9,10,11

Electric or Pneumatic Powered Drill Longevity Battery-powered drills are the least preferred. Since drills are relatively expensive, neurosurgeons “There is fluctuation of the strength that battery-powered prefer more durable drills to maximize value per drills provide whereas electric drills are the most smooth cost. and consistent.” – Neurosurgeon, UMich. However, "the portable battery instead of cord was big improvement.” Besides the drill itself, “Battery life matters a lot – Orthosurgeon, UW since most drills are already cordless” – Orthosurgeon, UW; “If battery doesn’t work or fit the Neurosurgeons prefer electric drills for detail and surgery will take longer”. – Orthosurgeon, Vanderbilt pneumatic for power. “Pneumatic have more torque and are louder and chatter more, electric are gentler on hands and quieter and better for finer operations--most places use electric.” – Neurosurgeon, UW Easily Reparable

Neurosurgeons prefer drills that can be easily fixed or troubleshooted by OR staff Multiple Uses since “many things could go wrong during surgery”. – Neurosurgeon, Columbia Neurosurgeons prefer surgical drills that can be used multiple times to reduce cost. When surgeons consider purchasing new drills, they value a maintenance service Drills should be easily sterilized by OR staff contract with the manufacturer. between procedures.

Part 1 Overview | Key Needs | Competitors | Hubly Compatibility

To address a major pain point for surgeons, Hubly can utilize drill bit compatibility and efficient assembly 12,13,14

Circular Drill Bits Numerous Drill Bit Sizes Drill kits should be equipped with Drill kits should be equipped with bits circular drill bits that are compatible of varying sizes. Through both with the respective drill. Surgeons interviews and expansive research, interviewed said they expect said A variety of drill bits are oftentimes too short. Hospitals compatibility based on competitors bits and quick look for companies to be open to releasing new bits resized and and hope to nullify the issue of assembly can be unraveling drill bits designed for novel technology a major differentiator for Additional Features Ease of Assembly Hubly As the hospital staff tend to assemble As in Phasor’s drill, a rotating drill drills, an identified pain point is that stopper can control the amount of they often have trouble putting drill bit exposed to the surface prior together drills for more specialized to operating. The stopper allows for operations. As surgeons may have to precise sizing of the bit before step in, the OR workstream is slowed penetration and can be placed against down overtime. the scalp to help prevent plunging

Part 1 Overview | Key Needs | Competitors | Hubly Temperature Control

Temperature control can decrease the rate of complications and improve a surgeon’s comfort level. 15,16,17,18,19 *NS = Neurosurgeon Minimizing Heat Generation Overheating neural structures can result in complications such as thermal necrosis. The high speeds that neurosurgical drills reach generate This is an issue of massive amounts of heat, making neurosurgeons more susceptible to safety too… I’ve injuring a patient. This is especially true for junior residents. seen people burn the bone, burn the Heat Dispersion dura. The excessive temperatures that neurosurgical drills reach detriments a -NS, Columbia neurosurgeons’ control, as the drill can overheat the user’s hands. Through We’ve worked with better heat dispersion, surgeons can avoid errors such as slipping. The engineering here for a maintenance of the ball bearing in a drill plays a large role in heat dispersion. while to make drills with better temperature Ease of Irrigation We typically dispersion. Neurosurgeons constantly ventilate or irrigate over the drill to combat irrigate over the -NS, UMich overheating. There are no means of determining the right amount of drill, which can irrigation fluid that prevents overheating and doesn’t inconvenience get messy at neurosurgeons during procedures. There are a few drills that attempt to times. address this issue through simultaneous irrigation and suction. -NS, Emory It would be great to have the ability to tell Temperature Detection the temperature, Neurosurgeons can’t objectively measure how hot the drill will get, which inhibits particularly when you’re them from accurately determining how much they need to irrigate during drilling. drilling near a Surgeons cannot monitor and quantify the drill temperature during procedures, n nerve or vessel. preventing them from ascertaining how close they are to causing injuries. -NS, UMich

Part 1 Overview | Key Needs | Competitors | Hubly Technological Features

Hubly can address surgeons’ concerns by including features that decrease complication and increase efficiency 20,21,22,23,24 Guidance Some surgeons believe adequate catheter If you’re good at drilling you’re never Really helpful with guidance exists and is not an important part of going to plunge. It just trainees because it the procedural landscape. error-proofs it but it can help them prevent mistakes. Others state that it’s always an issue with would be better if you master it. bedside procedures which are “blind.” Consider targeting junior residents who - Neurosurgeon, UCSF - Neurosurgeon, UW commonly need more assistance with guidance Plunge Prevention Desired to prevent thermal nerve trauma which has been seen to cause Catheter guidance Would like better necrosis fibrosis, degeneration, and already exists, not very electrode guidance common/important osteoclastic involvement. to help prevent part of overall skiving Some current perforator drills have a procedure landscape craniotomy limited clutch mechanism to

- UCSF neurosurgeon disengage the drill when it lurches - Neurosurgeon, UW (resident) forward. Since many older surgeons believe good Angular Precision The most Surgeons would like drills that can rotate to different angles. important thing is surgeons do not need plunge Difficult for angled drills to maintain speed and efficiency. the angle - unique prevention, Hubly should consider Skiving can become a serious issue when drilling at bleak angles and comfortable targeting residents and younger leading to deflection off the bone. surgeons. - Neurosurgeon, Cleveland Clinic Part 1 Overview | Key Needs | Competitors | Hubly Pricing

Hubly needs to consider the relationship between administrations and surgeons when pricing their drill. 25, 26,27,28,29 Neurosurgeons Submit Hospital Administration VendorVendor ShowcasesShowcases // MeetingsMeetings Recommendations Makes Final Choice

Hospital Admin Neurosurgeon Hospital administration tries to reduce Sterilization Costs: Physicians revealed that both the costs associated with surgeons. sterilization costs and costs of drill bits impact their purchasing decision. 1/10 Sterilization trays come back with a problem. Surgeons provide their recommendation on which drill is best. Cost-Benefit Ratio: Some surgeons view drills Hubly will need to Hubly showcases drills as just a commodity, others really think about the convince hospital to the vendors and the cost-benefit ratio. admin that the extra vendors provide cost or breaking brand feedback. loyalty is worth it. Bulk Purchasing: Hospitals tend to have partnerships with manufacturers and will buy in bulk from these companies to achieve cheaper Hubly costs and maintain relationships with these large Hubly needs to account for both hospital administration and the companies.

surgeon’s feedback regarding the pricing of their drill. Considerations Cost Additional

Part 1 Overview | Key Needs | Competitors | Hubly Competitor Analysis Integra LifeSciences Cranial Hand Drill

The Integra drill’s shortcomings are directly addressed by the Hubly Drill, justifying Hubly’s higher price point for the bedside. 30-37 Company Information Cranial vDrill Kit Assessment Design Single use $1200 hand drill Integra is routinely involved in M&A, features a manually adjusted currently have 50 subsidiaries and Neurosurgeon resident, UCSF stopper that is set to estimated There’s no real battery operated 22 branches. bone thickness to prevent reusable handheld drill that’s cheap, has plunge prevention - plunging. FDA reports 241 auto- used for bedside. stop mechanism problems. Integra makes tissue ablation equipment, Features Surgeons frequently lean their drainage catheters, bone weight into the drill, adding fixation devices, Neurosurgeon, Columbia pressure to the patient’s head, regenerative technologies, making careful retraction difficult. Plunging is more of an issue in and basic surgical bedside procedures; where you instruments. use old hand drill. 5 kits per case or individual purchase. Cost

Kits are fully stocked with surgical Neurosurgeon resident, UCSF Estimated $20 - $25 million revenue instruments, needles, syringes, EVDs are most common in ICUs impact because of decline in surgical sutures, and other necessary or ERs and are a staple in related procedures due to COVID-19 neurosurgical training that done materials with hand crank drills.

Part 1 Overview | Key Needs | Competitors | Hubly Ghajar Guide Cranial Drill – Neurodynamics Inc.

Hubly’s single-use drill should be able to match the key features of the Ghajar Guide Cranial Drill. 38,39,40 Overview The Ghajar Guide Cranial Drill is drill for ventriculostomies that comes with four main components: Palm Grip Drill, 4 Spacer Clips, Guide Base, Ventricular Catheter Insert.

Cost Manual Drilling This is a single-use drill that is made of The drill relies on the surgeon twisting it plastic. Thus, the cost of the drill is rather than having any electric or around $190, which is extremely cheap. pneumatic systems, which is more difficult to control. Lightweight and Versatile Limited Applications The drill is light, and the base can be During interviews, surgeons have swapped to use it as a catheter insert mentioned that plastic single-use drills tool. In addition, it has spacer clips as a tend to be flimsy and subpar and they method of plunge prevention. Benefits Drawbacks cannot be applied to every surgery. Relies on Anatomy Catheter Guidance This system has a ventricular catheter Plastic drills rely on anatomical insert that can be attached to the base landmarks of patient but if the patient of the drill. They also sell separate moves, the drill doesn’t work. It is also catheter routing system. difficult to control the trajectory and angle of drilling. Part 1 Overview | Key Needs | Competitors | Hubly Medtronic Midas Rex MR7 Drill

Medtronic’s drill is reliable, cost-effective, and highly integrated, making it a powerful direct competitor. 52-60 Company Info The drills are “very reliable and they do the job, which is what we like about it.” –NS, Harvard Medtronic is a key The motor and the MR7 lubrication system have been designed for improved reliability. player in the neurosurgical devices RELIABLE industry. Their The drill has a five-year shelf life. It’s easy to switch drill bits with a patented 3-step neurosurgical products system, which has a tactile and audible click to indicate that a step is complete. are extremely popular DURABLE and well established “The Midas drill can be used for everything…” –NS, Columbia Its high torque capacity within a compact size, makes it suited for a wide range of surgeries. in hospital systems across the nation. VERSATILE “It’s very powerful and has high speed burr.” – OS, UCSF Drill Info The drill has improved cutting performance due to increases in torque and power. The Midas Drill has a EFFICIENT pneumatic motor, a It has a standardized platform that includes existing Legend tools. coaxial hose system, The variety of attachment configurations lends to the drill’s angular flexibility. and a foot or finger COMPATIBLE controller. It meets “The primary issue is how much control you have with the drill.” –NS, Emory almost all the key The drill and foot pedal can be difficult to maneuver and result in skipping. needs, apart from technological features HARD TO CONTROL It’s “not convenient to operate with lots moving on the floor.” –NS, Harvard – plunge prevention The drill has cumbersome parts, such as the foot pedal and the bulky power cord. and catheter guidance. CUMBERSOME NS = Neurosurgeon “A lot of wiggle or chatter is irritating.” –NS, Emory OS = Orthopedic Surgeon The Midas Rex drill is noisy while running, which tends to hinder a surgeon’s focus. TOO LOUD Part 1 Overview | Key Needs | Competitors | Hubly Stryker � Drive & Cordless Driver systems

Stryker systems are successful among surgeons due to a carefully selected combination of features 41-51 Pi drive and CORE system Both Cordless Drivers Specialty NSE: Neuro, Spine, and ENT Intended for Ortho, Ortho Trauma, Sports Med

Sensitive: ID Touch Software: allows surgeons Ergonomics: motor Cordless: Stryker SmartLIFE Li-Ion batteries: long- Ergonomics to adjust how sensitive motor is to their touch. extender, textured lasting (2-2.5x shelf life), indicator light, voltage The motor applies pressure and torque to areas, neutral wrist regulation customized preferences position Compatibility: Part of the CORE system, which Compatibility Efficiency: Offers Drill bit compatibility and fit: secondary locking comes with a wide variety of features that ”significant increase” mechanism prevents loosening unifies operating room procedures across in torque from specialties, including two-foot pedals (electric *“Here at UW Orthopedics, we only use the Stryker previous Stryker Cordless Driver System 4 or 8. I prefer 8” motor), drill bits: saws, drills, ENT shavers, products bone mills,& Customizable cart to hold *“Here at Vanderbilt Orthopedics, we use the accessories Stryker Cordless Driver System 6 or 7. I’ve heard of Popularity* *Popular at Umich (not sure if � drive) other versions like the 8 but haven’t really used it.” Cost effective: volumetric optimization Cost** **$11,000 for used system 8 driver and complete **$2,250 per used � drive motor, CORE not battery set included *Interview Based **Stryker uses second party sellers ***No mention of plunge prevention nor guidance

“I like the Stryker Cordless Combo drill because it’s easier to put batteries in—you “An ideal drill is one that can also be used as a burr—the burr just kind of flip the back up and stick the battery in” settings on Stryker won’t spin fast enough” -Orthopedic surgeon, Vanderbilt -Orthopedic surgeon, Vanderbilt

Part 1 Overview | Key Needs | Competitors | Hubly Phasor Drill

As Phasor and Hubly have comparable drills, Hubly can capitalize by targeting residents and private practices 61,62,63,64 Ease of Use for Surgeons Drill Compatibility with Bits Surgeons have highlighted battery operated (cordless) drills as easy to use Phasor’s drill kit is equipped with a variety and maneuver around operating room of sizes in drill bits and was noted for its (“Sleek and effective, while being quick and easy assembly. Additionally, the lightweight in my hands”). Individuals were surgeon has more control on length of the concerned with battery life and whether or drill bit with rotating drill stopper for not the one and done drill plays into even greater precision. efficiency.

Comfort Compatibility Technological Features Cost of Single Use Drills Technology Cost Phasor seems to overemphasize their drill’s Phasor markets their drill as the same or plunge prevention capability. Through a even lower price than manual cranial drill guarantee for better angulation without kits. As the drill features and rotating stopper skiving on average, and temperature control can be desirable for primarily younger with relatively higher RPM, Phasor is marketed surgeons, they have received relatively towards the resident to aid with catheter faster approval by hospital and/or private misplacement. practice administration

Part 1 Overview | Key Needs | Competitors | Hubly EasyDrill Autostop Cranial Perforator - Micromar

The Micromar EasyDrill targets similar features to Hubly, and its partnership with Medtronic could be an inspiration. 65,66,67,68,69,70,71 Company Info Functionality Partnership with Medtronic EasyDrill’s auto-stop mechanism by Micromar is located in Medtronic’s global distribution sensing bone resistance ensures Brazil and produces a wide network allows EasyDrill to access plunge-prevention. variety of neurotechnology more markets. Its angle position feature guarantees products. Together they host joint marketing a perpendicular angle to the skull. Its annual revenue is USD events at conferences (ex. American EasyDrill is designed to reduce Association of Neurological $1-5M and it produced temperature during procedures. Surgeons (AANS)) to help increase 60,000 drills by 2017, brand awareness priced at ~ USD $150. EasyDrill is powered by locking onto pneumatic/electric motors. Micromar’s EasyDrill was approved by FDA 510 (k) in Versatility Quality 2015. EasyDrill is designed for BURR holes The non-slip tip ensures no Medtronic contacted and craniotomies procedures. Models skipping and smooth drilling during Micromar for a global come with different diameters and tip procedures. The drill’s sharp cut distribution agreement lengths are color coded. allows for quick and soft where it distributes under its perforations. brand name in US, Europe, Wide variety allows for all kinds of Asia & as Micromar in different uses: pediatric or adult, on Furthermore, the drill is Latin America. smooth or uneven surfaces, various lightweight on surgeons’ hands. Company Info cranial densities and internal diameters. The drills are also pre-tested one by Addresses a key need one at factory for QC.

Part 1 Overview | Key Needs | Competitors | Hubly Competitor Analysis Matrix

Medtronic & Micromar are Hubly’s largest competitors in technology, but no existing drill has Hubly’s combination of features

Ghajar Guide Midas Rex MR7 � drive & CORE Cordless EasyDrill Autostop Cranial Drill Kit Phasor Drills Cranial Drill Pneumatic system Drivers Series Cranial Perforator Textured grip Sensitive (ID Touch) Textured areas *Concerns about Cordless N/M *reliable, *noisy Motor extender Neutral wrist position Lightweight Ergonomics plastic Lightweight *bulky hand-piece Flexible cord Noise reduction *

Electric with foot SmartLIFE Li-ion Longevity Hand-cranked Hand-cranked Pneumatic w/ *foot pedal Battery operated Lock to both electric *bulky power cord pedals batteries and pneumatic

3-step system for Locking keyless chuck & High variety of drill Kit with drainage Huge variety with CORE Pediatric/adult attachment secondary locking bits and monitoring system Cranial densities Compatibility N/M Standardized platform for mechanism Adjust bit by length system Snap-Connect: Smooth/uneven skull variety of drill bits assembly & disassembly Pins, saws; hand, ankle Easy bit attachment

Temperature Max temp. reached far Withstand high RPM Designed for temp. N/M N/M Motor stays cool Heat-resistant batteries Control below burn threshold Irrigation control control Rotated drill stopper Swap base for Bone sensor and auto- Manual stopper for plunge prevention Technology catheter insertion Clutch plunge prevention stop for plunge for plunge N/M Angular precision Spacer clips for (85% success rate, burr) N/M prevention Features prevention Electrode and catheter plunge prevention Perpendicular angle guidance

List price over $40k, Pricing $1200 per drill $190, used as ~$2,250 ~$11,000 ~$500 $150 in Medtronic box add-on only generally cheaper Volumetric optimization

*retrieved*retrieved from from interview interview **N/M**N/M stands stands for for “not “not mentioned”; mentioned”; does does not not equal equal nonexistent nonexistent

Part 1 Overview | Key Needs | Competitors | Hubly Competitor Analysis

We assigned a quantified score to each of the key needs to assess competitor strengths and weaknesses

Ergonomics Temp Control Power/Longevity Compatibility Tech Features Pricing Methodology Rubric aimed to use number of features relevant to Hubly as guidelines

To account for interviews, we added 0.5 points for positive interview mention and did not consider complaints/negative aspects of technology unless mentioned in interview.

A “N/M” was counted as a 0 since Integra Micromar Ghajar Guide technology must not be successful

Method Strengths -Offers quantification for more accurate comparison -Strictly relevant to Hubly’s technology

Method Weaknesses -Does not take into account factors like Cordless target market and branding � drive & Phasor -Better option would be to give each key Midas Rex Drivers Series CORE system need a “weight” by surgeon surveys

*view full rubric in Appendix Overview | Key Needs | Competitors | Hubly Competitor Analysis Conclusion

Hubly is similar to other innovators and can compete with market leaders through branding and partnerships

Hubly has similar/more Click to edit Master subtitleadvanced style technology than the innovators and could capture the market with branding and potential partnerships. Cost-Effective Innovators Market Leaders Micromar and Phasor are innovators Medtronic and Stryker are the market leaders with the Ghajar Guide and Integra whose technological features exceed biggest market share, brand awareness/loyalty, and are affordable bedside the market leaders. Aside from stellar user base due to an extended presence in the market. options. They have minimal technology, their products are also well Their products are the most versatile to satisfy the key features and rounded in terms of all key needs. different needs of a wide user base. They also have a technology to maintain cost- With great product but relatively niche variety of related products which creates network effectiveness. They are very brand name, innovators collaborate with externality. specialized and therefore market leaders, such as Micromar’s However, hindered by their size, market leaders are slow are limited in growth. distribution agreement with Medtronic. to innovate. They look for innovators for new technology and collaborate/acquire.

Overview | Key Needs | Competitors | Hubly Hubly Analysis Hubly Analysis

Hubly’s drill has a unique combination of desirable technologies, yet has the potential to address unmet key needs

Benefits • Ease of Use and Comfort: finer control without drill jumping or skipping • Drill Design: cordless and very lightweight to hold • Versatility: the drill serves as catheter guide as well • Compatibility: allow for multiple bits and frequent stopping and starting • Ergonomics: make the drill easier to hold and maneuver for surgeon

Technologies • Plunge Prevention: keeps patients safer through unique feature • Catheter Guidance: key distinguishing factor as a selling point • No Cord: increases neurosurgeon’s mobility with drill • Battery Powered: higher degree of efficiency over conventional tools • Angular Precision: allows for drilling at variety of angles

Unmet Needs • Temperature: current drills do not address temperature concerns in surgery • Pricing: make sure the cost is competitive with other market drills

Part 1 Overview | Key Needs | Competitors | Hubly Hubly’s Value Proposition

As Hubly’s drill eases the stress of procedures, Hubly can find a target audience in younger surgeons

While established neurosurgeons may consider catheter placement as an entirely separate procedure, the benefit of streamlining drilling and accurate catheter placement can shine if marketed strategically.

Catheter Guidance Although there may be novel technology Hubly can and should stress the that could serve as a competitor, importance of the tripod guide hub as it mechanical pressure-based plunge can increase precision and decrease the prevention sets Hubly’s drill apart from rate of skiving. the clutch mechanism as a major asset. Angular Precision Plunge Prevention

Without the cord on the drills, The battery pack (depending on surgeons can reap the benefits of its life span) holds a higher enhanced mobility during degree of efficiency over lengthy procedures in the OR. conventional drills. No Cord Battery Power

Part 1 Overview | Key Needs | Competitors | Hubly Unaddressed Needs & Concerns

Hubly can overcome skepticism by highlighting its technological edge and improving its versatility and cost efficiency 72,73,74,75 *NS = Neurosurgeon

If you’re going to be running the drill, then you are Temperature Control going to know how Hubly’s Benefits not to plunge, Temperature control technology addresses a key Hubly must convince neurosurgeons that how not to skive. need that can improve patient care and creates a As for plunge their plunge prevention technology is more very tangible improvement in a neurosurgeon’s prevention… From -NS, Harvard effective than the clutch mechanism. level of comfort while performing surgeries. what I can tell, the Moreover, Hubly needs to prove that their drill cannot beat catheter guidance technology is not only the human. unique, but useful, as working surgeons Nothing I do in consider catheter placement as separate. -NS, UMich the operating Pricing room is inhibited Overcoming Skepticism by drills. It is imperative that the Hubly Drill is cost- …They do the The key hurdle for Hubly is overcoming competitive, as it needs to overcome hospitals’ job and it’s not -NS, Harvard neurosurgeons’ skepticism about the brand loyalty to established companies (namely the area I would need for a new drill, which means that Medtronic and Stryker). invest a lot of my the Hubly Drill’s efficacy must be brain power to proven to decrease the rate of change. complications in order to successfully -NS, Harvard market it to neurosurgeons.

Part 1 Overview | Key Needs | Competitors | Hubly Part 2 Purchasing Pathway & Marketing For the second half of this customer discovery, we analyzed the purchasing pathway of drills:

Distinguished Interviewed both Analyzed competitor between how private private and large success in purchasing practices and large hospitals to discover pathway marketing to hospitals operate the nuances in their create specific from a purchasing purchasing pathways strategies for Hubly standpoint Purchasing Pathway Interview Methodology 76,77 Targeted questions for key administrative personnel gave insights into the purchasing of surgical drills

By utilizing research knowledge from the Sent personalized emails using bulk 14 Hospital 25 Private Practice Midterm deliverable and keeping the email software and cold called private Administrators Physicians Hubly Drill’s unique features in mind, practice offices. If we received no we created specific questions about key response after 3-4 days, we followed up and sent our questions via email. aspects of the buying process. Key Questions

What would be some key incentives for purchasing drills Develop Find Reach out Conduct from relatively new companies? Interview Contacts to Contacts Interviews Guide How would the cost threshold differ for neurosurgical drills that incorporate new technology? Used university databases and hospital Analysts briefly shared their current employee directories to compile list of understanding of the system to ease hundreds of contacts. Leveraged personal into the conversation and personalized How does hospital administration contacts, located private practices and the interview guide to match their own vet new technology in surgical connected with doctors on LinkedIn. styles and the flow of the conversations. instruments?

Part 2 Overview | Pathway | Marketing | Hubly Key Players in Hubly Drill Purchasing Pathway 78-84 The purchasing pathway involves many players, but vendors can initiate and negotiate throughout the process.

Discovery Hospital Processing Purchase of Drill

Process Initiation Hospital Analysis Teams Purchasing and Contracts Team: Vendors bring product into Value analysis group: performs financial analysis negotiates a good price with vendor hospital (most popular) and checks for alike items. Sends to VAT Group Purchasing Organization: Hospital administration VAT (Value Analysis Team): has contract and handles financial analysis for larger looks into new product procurement personnel. A doctor who champions the purchases; allows for bulk buying due to safety or cost instrument can bring it to debate for vote. power concerns with existing product Materials Management/Purchasing: In touch with vendors Vendor & Sales Reps Doctors and nurses can Biomedical Department: Weigh in on certain technology, Since surgeons may ask for a certain bring product forward go to conferences and read literature, vet ideas. brand, good contracted instrument and champion it vendors should be able to cross Operations Team and Biomedical Engineering: reference costs between different checks instrument for patient safety as well as brands to prove that its vendor is the Conferences & Expos scope best option. Vendor Surgeons Capital Equipment Committees: prevents any one division Vendors should also be able to sends and IT from gaining full autonomy over decision-making process answer any technical questions sales reps attend and have brochures ready. *committees and teams are different per hospital Part 2 Overview | Pathway | Marketing | Hubly Hubly Drill Purchasing Pathways Overview 85-91 Although purchasing pathways have variable components, the general process follows a linear theme

Discovery Hospital Processing Purchase of Drill

Surgeons may Surgeons, hospital start process in administration, or perioperative Hospital Analysis (continued) Hospital Purchases between Hospital indicates cycles services can request to purchase Several committees go through Drill a drill and fill out form with value vetting process, operations and intent to vendor, analysis group biomedical engineering team vendor sends 1 Propose Purchase of 4 will check for patient safety invoice Drill 6

Conferences 3 & Expos 2 5 Contract Ongoing New drills are Hospital Analysis Consideration relations displayed by sales Hospital may check 7 (initial) Hospital may propose representatives to back with warranty or Process initiated Hospital performs financial contract with vendor surgeons attending reliability concerns, by administration analysis, checks for repeat depending on frequency, conference contract renewal, etc. per department equipment, surgeon can volume, and cost. every few years bring to debate and vote.

Part 2 Overview | Pathway | Marketing | Hubly Key Factors in Hubly Drill Purchasing Process 92-98 Administrators especially prioritize commercial and economic factors, unlike surgeons who focus more on tech.

Relationship with Vendor* If administrators have a good standing with a certain vendor, they prefer to work them because they find it much easier to procure a contract. They value Ease of Use & Surgeon Preference* communication, transparency, and flexibility. “Sometimes surgeons will only come to hospital if they use a specific drill that the surgeon likes.” Increasing surgeon satisfaction and employee Cost & Cost Coverage* retention can also instigate equipment purchases. ”Finance is our foremost concern, and we have to balance surgeon preference with capital budget.” This includes product quality, service inclusions, Product Standardization warranty details, trade-in value, and maintenance. Administrators determine if the drill they want to purchase is compatible with current drill bits and other daily activities. This also minimizes an inventory Patient Safety* expansion, which is favorable for administrators. Hospitals and private practices consider patient outcomes as one of the highest concerns, as it impacts customer experience. This factor has the Product Durability & Quality potential to trigger the purchasing process. “Quality is one of our key pillars. Our least favorite buy are replacements.” *Greatly emphasized in interviews. Product quality is greatly valued by both surgeons and administrators and indicates its long-term value.

Part 2 Overview | Pathway | Marketing | Hubly Key Factors in Hubly Drill Purchasing Process cont. 92-98 Key factors for administrators are dependent on hospitals’ values and characteristics such as size and mission.

Different Hospitals Have Different Needs Sterilization High level sterilization is desirable to both patients, Large Hospitals Private Practice surgeons, and as a result, administrators. This is especially important, as sterilization is often a large Surgical Hubly should have a high utilization expense for a hospital or private practice. Volumes rate within these settings

Complexity of The Hubly Drill must be compatible Sustainability Cases with any equipment used alongside it Administrators try to minimize problems with improper Harder for waste disposal. Therefore, reprocessed drills—which are Size of Easier for Hubly’s Hubly’s reusable drills that are sterilized and used for multiple Instrument specialization to patients—are desirable. specialization to stand out Inventory stand out Buys drills in Purchases fewer Finance bulk, but through Staff Training Requirements drills at a time Administrators value products that medical personnel contracts can independently troubleshoot without involving IT departments or technicians. Manufacturers can offer Strategic vision of institution trainings and ensure the product is easy to assemble. Personal motivations of managers and staff

Part 2 Overview | Pathway | Marketing | Hubly Private Practice Pathway Highlights 106-108 Private Practices value drill trials and consider their surgeons’ needs heavily before purchasing

Exposure Consideration Consultation

Conferences allow for hands-on Success rate and drill features After receiving recommendations experience for private practice are priorities when purchasing or trying out the drills at teams to test out devices before drills for both of these practices conferences, the practices making the purchase. (price was tertiary). Then, an interviewed consult with a Additionally, some practices emphasis placed on both the drill certain administrative team value referrals from their assembly time and efficacy of (usually consisting of a mixture of colleagues who have purchased being able to stick with a certain purchasing admin. and surgeons) certain drills for their respective brand for “the long-haul” (in and look for trials to make sure private practices as well. terms of drill kits and devices) everyone’s needs are being addressed before purchasing Key Interviews Dr. Shashan Najibi- Orthopedic Private Practice (Surgeon and member of the Administrative Purchasing Team) Dr. Ankit Indra- Neurosurgical Private Practice (Head of Purchasing Committee) Dr. Laura Ngwenya- University of Cincinnati Health (Director of Neurotrauma Center)

Part 2 Overview | Pathway | Marketing | Hubly Large Hospital Pathway Highlights 99-105 Price and market precedence can cause deviation from a large hospital’s purchasing pathway

Client-Admin Relationship Quotes Appealing to hospital administration is more “We buy 202 drills a year… a consequential. At the end of the purchasing disposable, nonsterile one. It process, the vendor works with the hospital’s really depends on the surgery legal team on the terms of an agreement, and particular item that’s which tends to last less than five years. needed.” —Michigan Medicine Novel Products If the medical instrument is brand new, large hospitals undergo a longer purchasing process in which they “In the past year… $100 review data, usage, and patient safety. More hospital million worth of requests stakeholders also get involved in the process, and multiple came in and the committee levels of approval are required. narrowed it down to $52 million.” $10,000 Threshold —Evergreen Health Items over $10,000 per unit are considered an annual spend or capital request item instead of a part of the operation budget. Large hospitals go through a more rigorous vetting process and attempt “We have one main supplier, to get a contract in place to protect the university and better pricing. and we procure all other supplies from a 3rd party vendor.” —Providence Health

Part 2 Overview | Pathway | Marketing | Hubly Marketing Strategy Marketing Overview 109-111 Large and private hospitals should be marketed to differently, yet surgeon interaction is key in both

Large Hospitals Private Practices

Academic conferences/expos to capture target Collaborate with established companies to capture surgeons/administrators market and distribution channels

Direct visits to hospitals by sales representatives Gifts and in-person visits to maintain relationship

Testimonial/referrals from peer surgeons to establish Sponsor clinical studies to establish credibility credibility

Effective distribution method (direct, partner/vendor, Tailor marketing strategy to specific audiences wholesale contracts) (senior, trainee)

Strengthen online presence (SEO) Videos, blogs, demos on social media

Part 2 Overview | Pathway | Marketing | Hubly Large Hospitals Marketing Strategy for Large Hospitals 110-120 For large hospitals, Hubly must market and distribute the drill effectively and support it with strong customer service.

Exposure Target Market Product Approval Distribution

Circulate Clinical Studies & Choose Distribution Method Appeal to Surgeons Literature Decide if partnership, direct selling, Surgeons can discover new drills at GPO or wholesale best suits Hubly. expos, in medical journals, and Conduct studies that measure the vendor appointments. the drill’s performance and impact on patient safety. 1 4 6 2 3 Build a strong online presence 5 Engage Hospital (SEO) 7 Administration Build Brand Name & Enhance brand and Hospital administration Loyalty Maintain strengthen website through attend conferences, process Show Hubly’s specialization Relationship SEO, writing white papers, staff requests, and are and unique features while Continue to assist hospitals and check in, and adding pictures and present throughout the fostering a strong partnership as hospital may have concerns about videos. purchasing process. with hospitals. warranty, reliability, contract renewal, etc. Part 2 Overview | Pathway | Marketing | Hubly Large Hospital Competitor Highlights 111-130 Hubly can foster enduring relationships with hospitals through customization and appealing to surgeons.

Customized Solutions Medtronic had more than 130 contracts in place with hospitals in Through working with hospital order to develop customized solutions and services. The company administration and surgeons to effectively works with and within hospitals to reduce risks involved in cater to the specific needs of any treatment and the costs of using their equipment and facilities. that hospital, Hubly can Medtronic has dedicated specialized teams that generate business establish long-lasting through maintaining strong relationships with physicians, given partnerships with large

Brand Loyalty Brand their ability to understand patient needs. hospitals.

Surgeon-Centric Approach By reinforcing a surgeon- Stryker contracted a creative agency to remake its website to centric approach on its become more surgeon-centric, as surgeons are a “vital audience”. website and attending To do this, Stryker’s website now includes collateral and is lead summits, Hubly can leverage generating, while focusing on qualities like user experience and surgeon opinion in its favor to expertise. In 2015 Stryker created an integrated communications convince large hospitals to campaign to market to surgeons as well. Stryker also regularly purchase. attends summits and conferences to reach surgeons. Target Market Target

Part 2 Overview | Pathway | Marketing | Hubly Strengths & Concerns with Large Hospitals 131-134 Hubly can present the Hubly Drill as unique and straightforward to better access the larger hospital market.

Buying Repeat Instruments Simple Product Offering Large hospitals are concerned about buying repeat instruments that can Unlike larger drill companies perform the same function. Hubly needs to prove that its that offer drill kits, the Hubly specialization is unique. Drill comes in a simple and efficient package. This Hospitals are Consolidating translates to less training for Hospitals are moving away from getting hospital IT staff. Concerns medical instruments based on surgeon Strengths preference and more towards consolidating the number of vendors they have. In addition, hospitals prefer buying from group cooperatives (i.e. Premiere)s before looking at 3rd party vendors. Thus, it will be harder for Hubly to establish contracts with large More Operations and teaching hospitals. There is a greater volume and scope of operations that is relevant to Hubly, Longer Negotiation Time Competitor Dominance increasing Hubly’s If Hubly Drill is offered as reusable (in Large competitors in the medical devices applicability. This also addition to the current disposable one), it translates to a larger market field have the advantage of numerous will exceed the $10,000 barrier. This for Hubly. patents and intellectual properties. This means that the hospital processing time can create barriers to entry for Hubly’s will be much longer. technology and marketing.

Part 2 Overview | Pathway | Marketing | Hubly Private Practices Marketing Strategy for Private Practices 135-140 Initiating and maintaining personalized relationships with surgeons is pivotal for success with privates

Exposure Target Market Product Approval Distribution

Circulate Clinical Studies & Establish Appeal to Surgeons Literature Surgeons can discover new drills at Conduct studies that quantitatively Distribution expos, in medical journals, and measure the the drill’s performance and Method vendor appointments. impact on patient safety. Decide whether 1 4 6 partnership, direct selling, GPO or wholesale best suits 3 Hubly. Build a strong online presence 2 5 Engage Hospital Maintain Relationship (SEO) Administration Build Brand Name & 7 Enhance brand and Surgeons attend conferences, Loyalty Utilize review/referral program and unexpected strengthen website through Guest blogging on client process staff requests, and care packages to strengthen brand appeal and SEO, writing white papers, websites can inherently funnel are present throughout the increase client satisfaction. Continue to check in and adding pictures and into SEO, stimulating word of purchasing process. for any concerns they may have. videos. mouth marketing while also serving as testimonials. Part 2 Overview | Pathway | Marketing | Hubly Private Practice Competitor Highlights 141-145 Promotional marketing and effective partnerships can cultivate a strong appeal for surgeons in private practices Promotional Advertising Phasor has capitalized on their targeted marketing strategy with promotional videos depicting less experienced residents/surgeons and referenced articles highlighting the catheter misplacement rates and Promotional Strategy dangers of thermal necrosis. Overall, Phasor has tailored their marketing to address certain pain points for younger surgeons who are looking Build on promotional for peace at mind in the OR. advertisements to the same

Target Market Target target group by utilizing guest blogs as testimonials that link Joint Marketing Hubly material (Demo videos, Micromar’s EasyDrill is featured in Medtronic’s Mobile Lab, a cutting- scientific journals, podcasts, etc.) edge road show that trains physicians on medical devices. Micromar also organized meetings with distributors to align business strategies, marketing plans, regulatory guidelines and quality control. Additionally, there were product training and exchange of experiences of various Partnerships surgical procedures including the technical and sales team of distributors.

Market Reach Market Consider working with established companies to Third Party Vendors break into the market and Integra increases its market reach by utilizing third party medical device develop efficient channels, vendors to distribute key products. These strategic partnerships help increasing the chances of being Integra focus their resources and attention on product development. acquired by a large company While this may speed up time-to-market, operational, compliance, and

Distribution data security risks must be considered.

Part 2 Overview | Pathway | Marketing | Hubly Strengths & Concerns 106-107 Though private practices might be more adaptable to new technology, its market size is rather limited

Pricing More Flexible Purchase Private practices might be more sensitive Without purchasing to pricing due to smaller cashflow. departments and contracts with big manufacturers in large hospitals, private practice surgeons have more Concerns autonomy and flexibility in Limited Scale the drills they prefer to Strengths purchase. With their smaller size and fewer patients, private practices may not regularly purchase new drills and theirs purchases are limited in scale.

Easier to Sell Directly Surgeons can be more easily reached through in person visits and online Surgeon Preference on Familiarity Shrinking Market Share testimonials, and surgeon Since many private practice surgeons Private practices have drastically opinion matters more in have many years of experience and also decreased from 95% in 2000 to 47% in private practices. practice at large hospitals, they might 2016, and continues to be on the decline. prefer specific drill models that they are Private practices are also more spread out more familiar with. geographically, thus harder to target. Part 2 Overview | Pathway | Marketing | Hubly Hubly Marketing Hubly Marketing 145-153 In order to effectively distribute the Hubly Drill, Hubly can develop brand identity and foster enduring relationships.

BUILD ENGAGE ESTABLISH DEVELOP BRAND STAFF PARTNERSHIPS LOYALTY Create a strong online Attend conferences, feature To gain administrators’ favor, Catering to the specific presence through SEO, in medical journals, and set focus on making each client’s needs of surgeons solidifies frequently updating social up vendor appointments to purchasing process easier relationships and provides a media, and guest blogging. appeal to surgeons and through greater flexibility understand of their key needs. Incorporating studies and hospital administration. Hubly and transparency. Hubly can Sending surprise care testimonials can further add can also offer free trials to also consider partnering with packages to clients further to Hubly’s credibility. enhance surgeon interaction. a well-connected distributor. increases satisfaction.

Part 2 Overview | Pathway | Marketing | Hubly Hubly Implementation

Pre-launch Hubly Drill Launch Post Launch Pre-acquisition

Internet Presence Hospital Trials Conferences Partnership

• Utilize online brand • Make the product as • Build product approval • Seek partnership with building to spread accessible as possible by engaging a broader an established company product awareness to promote usage to audience at conferences or third-party vendor for cross the chasm in the with demonstrations product distribution • Highlight credibility product adoption curve • Highlight Hubly’s • Enter partnership with by leveraging • Enter the purchasing innovation and loyal user base from surgeons using the uniqueness in the drill engagement with drills in trials pathway by engaging target market market surgeons and hospitals Appendix Appendix - Competitor Ranking table

Table for key needs quantification

1 2 3 4

Ergonomics Has little to no features Has few features Has some features for Light, gripping handle ergonomics Has 1)special grip features and 2) allows for wrist flexibility Customization options for ergonomics

Temp control Barely has any features Has a few features to cool Some features to cool temp Has active efforts to control temp ¼ or 2/4 temp (Around 2/4 ) (around ¾) 1.Minimizing heat generation 2.Heat dispersion 3.Ease of irrigation 4.Temperature detection power/longevity manual/hand-cranked pneumatic Battery Electric Compatibility Only one or two drill bit A few drill bit options with Limited drill bits/come with kit Lots of drill bit options, easy attachment of attachments limited range bits Tech features Only has 1/3 Only has 2/3 Has 1) plunge prevention 2) drill path guidance/ drill path guidance 3) catheter placement Cost Very expensive Relatively expensive Made effort to optimize cost Relatively cheap Key Needs - Citations

A numbered list of citations used in this presentation Ergonomics (1-5)

1.Interview with Karin Muraszko: Temperature Control (15-19) https://docs.google.com/document/d/1Atf4EVVFaiqgdcxd469GqZR8eS0CuutNopKeuDJNrdQ/edit 1.Interview with Christopher Winfree: 2.Interview with Mark Proctor: https://docs.google.com/document/d/18MALYCVQa14PJWFNbvh8KEKIg9mkULy6py- https://docs.google.com/document/d/17MlheKDqCtsss5MOTL5awlVMxKXIpCMj-xVR-zu_DGc/edit QN4q_N6M/edit 2.Interview with Karin Murascko: 3.Interview with Kimberly Hoang: https://docs.google.com/document/d/1SeHDwyT6yJEEe-ErHRWO- https://docs.google.com/document/d/1Atf4EVVFaiqgdcxd469GqZR8eS0CuutNopKeuDJNrdQ/edit oXQbm7bcKWBCwDDavKJB3w/edit 3.Interview with Kimberly Hoang: https://docs.google.com/document/d/1SeHDwyT6yJEEe-ErHRWO- 4.Interview with Lionel Metz: oXQbm7bcKWBCwDDavKJB3w/edit https://docs.google.com/document/d/1tlcaXwtasiG2yzK5LdBkpVBFl8uio9hYnF4cKdmbv7Y/edit 4.Interview with Hamid Borghei-Razavi: https://docs.google.com/document/d/1S2wG3xy5sXDO- 5.Interview with Michael Levitt: https://docs.google.com/document/d/1ecYxKQnOgy6NerevguS3t8g4JrFD_h-E- zMUyA5W-l4JrBJ63eNToaXdwqgQX4c/edit DCPmJVKzG8/edit?usp=sharing 5.Interview with Michael Steinmetz: https://docs.google.com/document/d/1nnEsqrCt5o_uVqSgD5J4lb7PMqTFIvma4wBdjI0s4Qo/edit Longevity (6-11) Technological Features (20-24) 6. Interview with Karin Muraszko: 6.Interview with Andrew Ko - https://docs.google.com/document/d/1Atf4EVVFaiqgdcxd469GqZR8eS0CuutNopKeuDJNrdQ/edit https://docs.google.com/document/d/1PY7YPCzGDB203FgabAm0snN8J8sU1ZF1Rw6x2mD-8_A/edit 7.Interview with Mark Proctor: https://docs.google.com/document/d/18MALYCVQa14PJWFNbvh8KEKIg9mkULy6py- 7.Interview with Thomas Wonzy - https://docs.google.com/document/d/1VVVUJGbt8zYmq- QN4q_N6M/edit 8.Interview with Brian Drolet: XcF5jAnz_6N1Tf4Wbt59-NiaVelwA/edit https://docs.google.com/document/d/1OEIlYYXk1zJXLpolfxrRyfPB9dCvp0mHgR2bralHpjU/edit 8.Interview with Hamid Borghei-Razavi - https://docs.google.com/document/d/1S2wG3xy5sXDO- 9.Interview with David Genelberg: zMUyA5W-l4JrBJ63eNToaXdwqgQX4c/edit https://docs.google.com/document/d/1JVw_cDrBg-rXtu4WiGDhQhNq4htET1d9AyiRpfN4PXE/edit 9.Interview with Mark Porter - 10.Interview with Jason Hauptman: https://docs.google.com/document/d/18MALYCVQa14PJWFNbvh8KEKIg9mkULy6py-QN4q_N6M/edit https://docs.google.com/document/d/1pSnVEzfy1kcJ6YQXYKy2bflNH7GEHxctuKsZlDIhdxA/edit 10.Interview with Jason Hauptman - 11.Interview with Seth Leopold: https://docs.google.com/document/d/1pSnVEzfy1kcJ6YQXYKy2bflNH7GEHxctuKsZlDIhdxA/edit https://docs.google.com/document/d/1m2moPhanFk-vAvdr7ZIbvxTTcDgrlc3Z_dZhTxngGvM/edit Pricing (25-29) Compatibility (12-14) 1.“1/10 sterilization trays come back with some sort of problem” 1. Circular Drill Bits 2.“Lots of different drills on the market, but they’re the same ‘commodity item’ so if there’s 2. Variety of Drill Bits included in kits one that’s cheaper I would buy that” 3.“The cost-benefit ratio is something we think about all the time” 3. Cranial Drilling Device with different kits 4.now they choose to use competitive contracting with vendors--buy all the instruments from all a single vendor to reduce costs 5.Idea of trying to reduce physician usage cost is huge among hospitals 1. Competitor Analysis - Citations

Numbered list of sources used in the presentation

Integra LifeSciences (30-37) Midas Rex MR7 Pneumatic Surgical Drill – Medtronic (52-60) 1.Integra LifeSciences Competitor Research - Shehbaz 1.Midas Rex MR7 Competitor Research: 2.https://docs.google.com/document/d/1VVVUJGbt8zYmq-XcF5jAnz_6N1Tf4Wbt59-NiaVelwA/edit https://docs.google.com/document/d/18KcgzEwLzO9QpgEqzAs3PvtlOnx1DW_km4N94r2ObYk/edit 3.https://docs.google.com/document/d/1f5vtriF7j1Uiw6hEBG4DKBhcLb20GBSTmBxZorpjlW0/edit 2.https://www.medtronic.com/us-en/healthcare-professionals/products/neurological/powered-surgical- 4.Covid-19 losses: Integra LifeSciences Reports First Quarter 2020 Financial Results instruments/midas-rex-mr7-high-speed-pneumatic-drills.html 5.Integral kit: https://www.integralife.com/file/general/1453795536-2.pdf 3.https://www.kebomed.dk/files/21/toolcatalog.pdf 6.Added weight and pressure to patient's head: 4.https://www.accessdata.fda.gov/cdrh_docs/pdf18/K183515.pdf https://biodesign.seas.harvard.edu/files/biodesignlab/files/2013_-_loschak_- 5.Interview with Kimberly Hoang: https://docs.google.com/document/d/1SeHDwyT6yJEEe-ErHRWO- _assured_safety_drill_with_bi_stable_bit_retraction_mechanism_0.pdf oXQbm7bcKWBCwDDavKJB3w/edit 7.FDA complaint: Powered) Trephines & Accessories (compound Burrs Drills FDA Classification, 6.Interview with Mark Proctor: Life Cycle Events [3706] https://docs.google.com/document/d/18MALYCVQa14PJWFNbvh8KEKIg9mkULy6py-QN4q_N6M/edit 8.Class 2 Device Recall Integra Cranial Access Kit 7.Interview with Christopher Winfree: Ghajar Guide Cranial Drill – Neurodynamics Inc. (38-40) https://docs.google.com/document/d/17MlheKDqCtsss5MOTL5awlVMxKXIpCMj-xVR-zu_DGc/edit 1.Ghajar Guide Website 8.Interview with Lionel Metz: https://docs.google.com/document/d/1tlcaXwtasiG2yzK5LdBkpVBFl8uio9hYnF4cKdmbv7Y/edit 2.Flimsy and Subpar 9.Interview with Michael Steinmetz: 3.Anatomical landmarks https://docs.google.com/document/d/1nnEsqrCt5o_uVqSgD5J4lb7PMqTFIvma4wBdjI0s4Qo/edit Styker pi drive and CORE and cordless systems (41-51) Phasor Competitor Slide (61-64) 1.https://neurosurgical.stryker.com/products/pi-drive-plus-motor/ 10.Interview with Ortho Surgeon who Owns his Priv. Practice (Soheil Najibi) 2.https://aamedicalstore.com/products/stryker-pi-drive-motor-compatible-with-core-console 11.Rapid Stopping Mechanism 3.https://neurosurgical.stryker.com/products/core-2-console/: 12.Phasor Case Study 4.https://news.thomasnet.com/fullstory/high-speed-medical-drills-are-fully-customizable-20057032 13.Drill Kit specifics and Rotating Drill Stopper 5.https://neurosurgical.stryker.com/products/pi-drive-motor/ 6.https://www.strykermeded.com/media/2269/system-8-brochure.pdf Micromar (65-71) 7.https://ortoday.com/stryker-system-8-power-tools/ 1.https://www.micromar.com/en/aplicacao/easydrill-cranial-perforator/ 8.https://www.google.com/search?q=stryker+corddles+system+8+drive+and+sabo+cost&sxsrf=ALeKk01eAkNu 2.https://www.micromar.com/en/1705/easydrill-cranial-perforator-on-aans/ iwcpH66aOfxuONQR2yuO2w:1593581080389&source=univ&tbm=shop&tbo=u&sa=X&ved=2ahUKEwjOkd6Rq 3.https://www.medicalexpo.com/prod/micromar/product-83885-646377.html KvqAhXMvJ4KHRWZBGUQsxh6BAgMEC4&biw=1440&bih=789#spd=3088607619983796089 4.https://www.linkedin.com/pulse/micromar-easydrill-cranial-perforator-successful-case-antonio- 9.https://www.strykermeded.com/media/1041/cd4-sabo2-family-brochure.pdf martos/ 10.Interview with Brian Drolet: 5.https://healthmanagement.org/products/view/cranial-perforator-easydrill-micromar https://docs.google.com/document/d/1OEIlYYXk1zJXLpolfxrRyfPB9dCvp0mHgR2bralHpjU/edit?usp=sharing 6.https://www.youtube.com/watch?v=WNmnBz1d8gE 11.Interview with David Gendelberg: https://docs.google.com/document/d/1JVw_cDrBg- 7.https://www.youtube.com/watch?v=Dr_TnHTCbu0 rXtu4WiGDhQhNq4htET1d9AyiRpfN4PXE/edit?usp=sharing Additional Citations

Hubly analysis section - citations

Unaddressed Needs & Concerns (72-75) 1.Interview with Mark Proctor: https://docs.google.com/document/d/18MALYCVQa14PJ WFNbvh8KEKIg9mkULy6py-QN4q_N6M/edit 2.Interview with Karin Murascko: https://docs.google.com/document/d/1Atf4EVVFaiqgdcxd4 69GqZR8eS0CuutNopKeuDJNrdQ/edit 3.Interview with Kimberly Hoang: https://docs.google.com/document/d/1SeHDwyT6yJEEe- ErHRWO-oXQbm7bcKWBCwDDavKJB3w/edit 4.Interview with Michael Steinmetz: https://docs.google.com/document/d/1nnEsqrCt5o_uVqSg D5J4lb7PMqTFIvma4wBdjI0s4Qo/edit Part 2 Citations

•Interview Methodology - (76-77) • https://docs.google.com/document/d/1eCeECEwi4Qz_tCtMPsxC28PBFGu-xX0rkRO8Sqm9fzg/edit • https://docs.google.com/document/d/1a2VwJfYK5VmzGEfUHNwkIup4n6BU4I-SyW4p3-VOGGo/edit •Key Factors - (92-98) •Key Players - 78-84 • https://www.boardvitals.com/blog/surgeons- • https://www.boardvitals.com/blog/surgeons-purchasing-decisions-power/ purchasing-decisions-power/ • https://think.storage.googleapis.com/docs/how-hospital-administrators-make-purchase-decisions_research- • https://incrowdnow.com/wp- studies.pdf content/uploads/2019/09/InCrowd-Hospital- • https://cdn.hpnonline.com/inside/2010-03/1003-SIG.html Purchasing-Decisions-2019.pdf • https://www.surgicalinstruments.com/resources/tips-from-the-experts • https://incrowdnow.com/blog/need-know-hospital- • https://www.gaebler.com/Marketing-a-Surgical-Instruments-and-Supplies-Business-8421.htm admin-purchasing-behaviors/ • https://www.verywellhealth.com/commonly-used-medical-supplies-2318224 • https://think.storage.googleapis.com/docs/how- • https://docs.google.com/document/d/10nt5F68cAuuZfrhSvwpHw9acVWapQbTQeyUln7ThJqM/e hospital-administrators-make-purchase- dit?usp=sharing decisions_research-studies.pdf • https://docs.google.com/document/d/1_H8cNAozFTUy8- • https://docs.google.com/document/d/12KW8gqWR- tC6y2B77rmWTcS3_zcleeIgScopBc/edit?usp=sharing 5aIPxcLBIGo8wRHsyt2NZTtAgMwNZZuzbo/edit?us p=sharing •Purchasing Pathway Overview- 85-91 • https://docs.google.com/document/d/10nt5F68cAuu • https://www.boardvitals.com/blog/surgeons-purchasing-decisions-power/ ZfrhSvwpHw9acVWapQbTQeyUln7ThJqM/edit?usp =sharing • https://cdn.hpnonline.com/inside/2010-03/1003-SIG.html • https://docs.google.com/document/d/1_H8cNAozFT • https://www.surgicalinstruments.com/resources/tips-from-the-experts Uy8- • https://www.gaebler.com/Marketing-a-Surgical-Instruments-and-Supplies-Business-8421.htm tC6y2B77rmWTcS3_zcleeIgScopBc/edit?usp=shari • https://www.verywellhealth.com/commonly-used-medical-supplies-2318224 ng • https://docs.google.com/document/d/12KW8gqWR- 5aIPxcLBIGo8wRHsyt2NZTtAgMwNZZuzbo/edit?usp=sharing • https://docs.google.com/document/d/10nt5F68cAuuZfrhSvwpHw9acVWapQbTQeyUln7ThJqM/e dit?usp=sharing

55 Part 2 Citations

•Large Hospital - decision pathway highlights (99-105) •Marketing Strategy (Large Hospitals) (110-120) • https://docs.google.com/document/d/12KW8gqWR- • https://docs.google.com/document/d/12KW8gqWR- 5aIPxcLBIGo8wRHsyt2NZTtAgMwNZZuzbo/edit?usp=sharing 5aIPxcLBIGo8wRHsyt2NZTtAgMwNZZuzbo/edit?usp=sharing • https://docs.google.com/document/d/1vI_Er_QBmhSHLi- • https://docs.google.com/document/d/1_H8cNAozFTUy8- MtMrehrdUwYtNjxKhji1sHNZSjsk/edit?usp=sharing tC6y2B77rmWTcS3_zcleeIgScopBc/edit?usp=sharing • https://docs.google.com/document/d/10nt5F68cAuuZfrhSvwpHw9acVWapQbTQey • https://docs.google.com/document/d/10nt5F68cAuuZfrhSvwpHw9acVWapQ Uln7ThJqM/edit?usp=sharing bTQeyUln7ThJqM/edit?usp=sharing • https://docs.google.com/document/d/1_H8cNAozFTUy8- • https://www.agencycreative.com/case-study/stryker/ tC6y2B77rmWTcS3_zcleeIgScopBc/edit?usp=sharing • https://neurosurgical.stryker.com/events/calendar/ • https://incrowdnow.com/blog/need-know-hospital-admin-purchasing-behaviors/ • https://think.storage.googleapis.com/docs/how-hospital-administrators-make- • https://incrowdnow.com/wp-content/uploads/2019/09/InCrowd-Hospital- purchase-decisions_research-studies.pdf Purchasing-Decisions-2019.pdf • https://www.massdevice.com/five-marketing-essentials-medical-device-startups/ • https://healthlinkdimensions.com/healthcare-marketing/how-do-hospitals-make- • https://www.tslmarketing.com/medtech/medical-technology-device-marketing- purchasing-decisions/ strategy • https://www.curotec.com/insights/6-proven-strategies-for-marketing-your-medical- •Private Practice - decision pathway highlights 106-108 device/ • https://docs.google.com/document/d/1IHN9_zP7FxE_4CyjpHNF5nuKXtL0jeAMnTX • https://refinelabs.com/blog/5-reasons-medtechs-need-to-change-their-go-to-market/ pbYy37ZA/edit • https://www.callboxinc.com/growth-hacking/how-to-sell-medical-devices-to- • https://docs.google.com/document/d/1r4f1dwPy4n4maxCzA_24hv- hospitals/ EheDpATuaJkKEko1tfnE/edit • https://www.pcma.org/6-ways-medical-meetings-prove-value-exhibitors/ •Competitor Highlights/Examples (121-130) • https://www.agencycreative.com/case-study/stryker/ •General market information(109-111) • https://neurosurgical.stryker.com/events/calendar/ • https://www.carevoyance.com/blog/private-practice-doctors • https://marketrealist.com/2016/11/how-are-strykers-core-strategies-working-toward-its- • https://www.carevoyance.com/blog/the-most-surprising-thing-about-selling-to- growth/ physicians • https://www.mddionline.com/stub/strykers-getaroundknee-direct-consumer- • https://www.repsly.com/blog/field-team-management/how-to-sell-expensive- medical-devices campaign-has-been-successful-will-hips-see-one • https://campaignbrief.com/stryker-launches-a-new-campaig/ • https://www.tslmarketing.com/medtech/medical-device-digital-marketing-report-card-medtronic • http://fernfortuniversity.com/term-papers/swot/1433/1093-medtronic.php • https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1063&context=honorstheses • https://marketrealist.com/2015/12/assessing-medtronics-marketing-sales-strategy-2015/ • https://www.mbaskool.com/marketing-mix/products/17061-medtronic.html Part 2 Citations

•pro/con large hospitals (131-134) •Recommendations – (145-153) • https://docs.google.com/document/d/12KW8gqWR- • https://docs.google.com/document/d/12KW8gqWR- 5aIPxcLBIGo8wRHsyt2NZTtAgMwNZZuzbo/edit?usp=sharing 5aIPxcLBIGo8wRHsyt2NZTtAgMwNZZuzbo/edit?usp=sharing • https://docs.google.com/document/d/10nt5F68cAuuZfrhSvwpHw9acVWapQbTQey • https://docs.google.com/document/d/1vI_Er_QBmhSHLi- Uln7ThJqM/edit?usp=sharing MtMrehrdUwYtNjxKhji1sHNZSjsk/edit?usp=sharing • https://docs.google.com/document/d/1_H8cNAozFTUy8- • https://docs.google.com/document/d/10nt5F68cAuuZfrhSvwpHw9acVWapQbTQey tC6y2B77rmWTcS3_zcleeIgScopBc/edit?usp=sharing Uln7ThJqM/edit?usp=sharing • https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1063&context=honorsth • https://docs.google.com/document/d/1_H8cNAozFTUy8- eses tC6y2B77rmWTcS3_zcleeIgScopBc/edit?usp=sharing • https://think.storage.googleapis.com/docs/how-hospital-administrators-make- •Marketing Strategy (Small Hospitals) (135-140) purchase-decisions_research-studies.pdf • https://thescript.zocdoc.com/best-marketing-strategies-for-medical-practices/ • https://www.tslmarketing.com/medtech/medical-device-digital-marketing-report- • https://jamanetwork.com/journals/jamasurgery/fullarticle/508661 card-medtronic • https://www.practiceofthepractice.com/top-5-reasons-to-blog-in-private-practice/ • https://www.linkedin.com/pulse/micromar-easydrill-cranial-perforator-successful- • https://www.medicaleconomics.com/view/should-your-practice-have-blog case-antonio-martos/ • https://blog.definitivehc.com/why-market-to-doctors-at-private-practices • https://docs.google.com/document/d/1IHN9_zP7FxE_4CyjpHNF5nuKXtL0jeAMnTX • https://docs.google.com/document/d/1IHN9_zP7FxE_4CyjpHNF5nuKXtL0jeAMnTX pbYy37ZA/edit pbYy37ZA/edit

•Competitor Highlights (141-145) • https://www.integralife.com/biomaterialpartnerships • https://twitter.com/mdtneurosurgery/status/991774798538665984 • https://www.micromar.com/en/633/i-distributors-meeting-week/ • https://www.micromar.com/en/444/micromar-at-1st-joint-meeting-on-sfn-of-the-latin- countries/