A show of hands opens the session: nearly everyone has piloted, far fewer have scaled, and everyone who scaled hit problems they did not anticipate. What makes the panel useful is where the four answers do not point. None of the executives — running a healthcare manufacturer, a payments network, an energy producer and a consultancy — blames model capability, cost or data infrastructure. All four describe an organisational constraint. McInerney's account is the sharpest and is an account of failure: eighteen months of executive advocacy and democratised model access produced nothing, until three hundred senior leaders were put in a room for two days and made to build agents themselves. Jakobs supplies the mechanism worth copying, measuring returned clinician time against the three to seven minutes a patient currently receives rather than against cost. Nasser rejects the premise that acquiring compute produces value, and locates returns in operations rather than in the back-office functions most organisations automate first.