After more than a decade working in healthcare IT, supporting payers, providers, and state programs through major system overhauls, I’ve learned that success isn’t just about the technology.  In fact, more often than not, it’s the human systems that falter.  You can have a brilliant platform, well-documented requirements, and a big-name vendor behind you, but if the implementation doesn’t stick, or worse, causes more problems than it solves. you’re left with disillusioned staff, overextended timelines, and outcomes that barely move the needle.Let’s talk about why that happens.

1. Unrealistic Timelines and Overpromised Outcomes

The pressure to hit deadlines, often driven by regulatory mandates or budget cycles means teams are frequently asked to sprint through phases that require thoughtful, deliberate planning. It’s easy to say “we’ll fix it in Phase 2,” but anyone who’s been in this space long enough knows Phase 2 rarely comes. Or when it does, the organization is too fatigued to push for real change. And then there’s the promise of transformation. We sell systems as if they’ll solve every operational bottleneck, reduce costs, and boost compliance in one fell swoop. But systems don’t magically correct broken workflows they expose them. That’s uncomfortable, and it’s something many teams aren’t fully prepared to address.

2. Stakeholder Fatigue and Misalignment

One of the most common red flags I see is when business, clinical, and IT stakeholders nod along in early workshops, but they’re not aligned. Maybe they’re speaking different operational dialects. Maybe they’re nodding just to get out of the meeting.  Fast forward six months, and the cracks start to show. Clinical users feel the system was “built without them.” The claims team is manually correcting configurations that weren’t properly vetted. Executives are asking why the dashboards don’t reflect the outcomes they pitched to the board.  The truth? If alignment wasn’t achieved early on, the system can only reflect the gaps, not bridge them.

3. The Disconnection Between System Configuration and Operational Reality

Here’s a painful truth: most of the configurations I’ve inherited weren’t wrong they just weren’t right enough. The system was set up to work in theory, not in the messy, exception-riddled world of real healthcare operations. I’ve seen prior authorization systems fail because no one mapped state Medicaid policy nuances into the configuration. I’ve seen provider portals crash and burn because eligibility feeds were assumed to be “plug and play.” I’ve seen beautiful care management platforms shelved because the nurses using them were never trained on why it was built the way it was. Bridging that gap between theory and practice takes more than requirements gathering, it takes people who understand both systems and the realities of care delivery.

4. Lack of Change Management and Cultural Readiness

We say “training” when we mean “change management,” and we shortchange both.

Rolling out a system isn’t just about learning how to click the right buttons, it’s about shifting how people think about their work. That requires context, empathy, and ongoing reinforcement. If users don’t see how the system helps them do their jobs better (not just differently), adoption will suffer.  In healthcare, we’re asking clinicians and administrative staff – already stretched thin – to absorb one more change. If we don’t meet that ask with honesty, clarity, and support, we can’t expect success.

5. Failure to Design for Iteration

Healthcare is not static. Policies change. Vendor contracts shift. Member populations evolve. Yet too many implementations treat go-live as the finish line instead of a milestone.

What’s often missing is a plan for continuous configuration, governance, and feedback. Without that, even the best systems will degrade over time, becoming just another tool people work around instead of with.

So, What Can We Do Differently?

As someone who lives in the space between vision and execution, here’s what I’ve found works best:

• Start with humility. No system will fix everything. Own that early.
• Build in breathing room. Pad timelines to account for rework, iteration, and discovery.
• Invest in translation. You need people who can bridge IT and clinical/business operations. These roles are critical and often underappreciated.
• Don’t skip governance. Ongoing system stewardship ensures you don’t just launch, you evolve.
• Reframe “training” as engagement. Make sure users understand the why, not just the how.

Final Thoughts

Healthcare IT is one of the most complex, high-stakes environments you can work in. The technology is only one part of the equation. Success lives in the messy, human, day-to-day reality of the people who use the systems we implement.  If we start respecting that complexity and designing with it in mind we might just get closer to the transformation we keep promising.

I’ll leave you with this image, it’s a strong summary of the common pitfalls in system implementation.

By Theo Thalassites, Principal Solutions Architect, Impresiv