Health System Transformations Succeed When Operations Owns What IT Cannot

Most large digital transformations at health systems stall because leaders never align on priorities and ownership. Everyone signs off in the kickoff meeting, then drifts back to competing demands once the room clears. When the rollout slips, IT gets blamed for a problem that starts above it.

Pamela Austin, a Healthcare IT Executive and Advisor, has spent more than three decades leading technology and transformation across complex, multi-hospital health systems. She held CIO and operational leadership roles across large, multi-hospital health systems in the Southeast, where she led multiple large-scale EMR deployments over more than three decades. Working both sides, technical and operational, gives her a sharp read on where these efforts break down.

"The system rarely fails first. Alignment does, and the system just exposes it," Austin said. The technology that buckles under a transformation usually surfaces problems that predate it, like unclear expectations or leaders who define success differently and never reconcile it.

• The convenient culprit: When a project stumbles, the simplest explanation tends to win out. "We just blame the software. But it is often a failure at the leadership level, and we just have a hard time owning that," Austin said. The tougher work is change management, and in healthcare, it hits especially hard. A clinician learning a reworked platform is effectively starting a new job, and bringing people through that shift is where adoption rises or falls. A tool dropped on staff with no preparation leaves the rollout exposed long before anyone logs a defect.

• Delivery without dialogue: Co-designing the platform with its users starts before a line of code ships. "Oftentimes from an IT perspective, communication is one-way. IT simply delivers the system, expects everyone to use it, and marches on. Then we wonder why it fails," Austin said. The team sits beside clinicians and maps the process end to end before deciding what to automate, adapting to how each person takes in information; some want it written down, others want to be walked through it at the keyboard. Otherwise, staff build their own workarounds until the design on paper stops mattering.

• Death by priorities: Misalignment hides inside the sheer number of competing priorities, where any single initiative risks becoming one more line on a crowded list. "If the mandate is not coming from the top down, that project just becomes one of the other 50 we've got going on, and that is where you start seeing adoption wane," Austin said. A clear directive from the CEO, the board, or whoever sets the direction keeps things moving, but a mandate alone doesn't finish the job. Austin pressed leaders to pin down what success looks like in measurable terms up front and to keep checking whether the work is on track to hit those numbers. Without that, an organization can declare a win while quietly missing the outcome it's after.

Just 35% of large digital transformations meet their stated goals, and the failures cluster around organizational fault lines that cut across industries. A hospital feels this acutely, where one program touches operations, clinical staff, the revenue cycle, and IT at once.

• The downstream tax: A revenue cycle runs from patient access all the way to a paid claim, with a long chain of handoffs in between. "If you automate something on the front end, but you just move the work and wreck a downstream workflow, you haven't transformed anything. You just moved it down," Austin said. Getting it right means tracing the whole process from start to finish and running parallel tests to find where it snags before anyone commits. Staff tend to want the software to reproduce the old way of working, so much of the job is getting them to accept that the workflow now runs differently. That also forces leaders to spell out, in concrete terms, what they set out to change.

• Not an IT project: Once the change is defined, the next question is who carries it out. A transformation usually arrives looking like a technology purchase, so it lands on IT by default. That leaves the team running the tools responsible for a result it was never built to deliver. Ownership belongs with operations. "You have to have an operational owner from the very beginning, even before the ink is dry on the contract. Who has the authority to make decisions? Who has the authority to change workflows? If they're not in it from the start, and they truly don't believe in the transformation, it'll never happen," Austin said.

Austin asked for plenty of discipline around these projects, with the metrics and accountability to keep them honest. Her own test for whether one succeeds is simpler, and it sits entirely with the people using the tools. Reaching it depends on the alignment work that leaders keep mistaking for someone else's job. "The technology needs to fade into the background as they care for a patient," she concluded.

The views and opinions expressed are those of Pamela Austin and do not represent the official policy or position of any organization.