Grounded by pilots: Why healthcare innovation rarely takes off

Let’s face it—when it comes to innovation, healthcare is both a champion and a chronic underperformer. We run pilots like there’s no tomorrow, happy to experiment with new tools, AI solutions, or programs on a small scale. But when the results look promising, what do we do? Too often, we leave these innovations to die on the vine, neatly contained within the pilot’s boundaries, reluctant or unable to roll them out across the enterprise.

If this resonates, you’re not alone. Sameer Badlani, MD, the chief digital officer at M Health Fairview, observed in a recent interview that “healthcare has more pilots than the airline industry.” The industry’s pervasive fear of failure—any failure, even minor flops without significant risk of patient harm or financial drain—keeps innovation locked up tight. This cautiousness doesn’t just slow us down; it actively undermines our efforts to improve patient care, clinician efficiency, and organizational performance.

Why the relentless piloting?

Healthcare’s over-reliance on pilots stems from a deep-rooted cultural conservatism. The industry places patient safety at the pinnacle (as it should), but we’ve started applying the same high-stakes mindset to every small piece of innovation, regardless of the actual risk involved. This caution leads to an “expensive hobby” mentality, where we pour resources into pilot after pilot without an actionable plan to deploy the solution system-wide.

Here’s the reality: while risk aversion has its place, not all innovation carries the same level of risk. Some solutions, especially those focusing on operational improvements or clinician support, could transform workflows and alleviate burnout, if only we were willing to take the leap. But we don’t. Instead, the promise of improvement stalls out before it can make a meaningful impact on our bottom line, patient outcomes, or pajama time.

The cost of underutilized innovations?

The consequences? Physicians, nurses, and other clinicians are denied potentially game-changing tools, patients miss out on better care, and we remain stuck with the same inefficiencies. And it’s not just theoretical—think about AI-driven decision support tools, predictive analytics for patient outcomes, or digital systems designed to streamline documentation. These tools could save time, reduce clinicians' cognitive load, and potentially improve care quality. But too often, they never reach the point of enterprise-wide integration.?

Pilots are resource intensive. Every additional pilot that doesn’t scale adds to sunk costs without delivering full ROI.

The hesitation to scale is also baffling because it’s expensive. Pilots are resource intensive. Every additional pilot that doesn’t scale adds to sunk costs without delivering full ROI. We’re left with a fleet of “nice-to-haves” that never evolve into essentials because we treat them as isolated experiments instead of strategic assets.?

Enter the “scaling machine”: a new paradigm?

So, what’s the solution? Healthcare organizations need a “scaling machine” or a standardized, rigorous process to evaluate and then deploy successful pilots across the enterprise. This scaling machine would help take innovations beyond the laboratory and put them where they belong—in every clinic, every department, and every workflow that could benefit. The goal would be to ensure that every clinician is working at the top of their license and every employee is?doing work that only a human can do.?

Here’s how a scaling machine might look:?

• Set criteria for success upfront: Before a pilot even begins, define what success looks like. This isn’t about ambiguous “soft wins” but concrete KPIs that make scaling a no-brainer if achieved.?

• Dedicate a scaling team: The pilot team might be focused on testing and tweaking, but the scaling team needs to focus on standardization and adoption. This team should have the mandate, budget, and authority to take solutions from “good idea” to “must-have.”?

• Apply the “80/20 rule”: Not every department or setting needs to see every feature work at 100% before it’s worth deploying. If the pilot meets 80% of its goals in 80% of settings, that’s usually sufficient to justify moving forward. Healthcare can’t afford to wait for 100% perfection in a world that moves as quickly as today’s digital landscape.?

• Build cultural buy-in early: Scaling is as much about change management as it is about technology or operations. Identify champions from the start, involve end-users in pilot design, and communicate the broader vision. Scaling a program only works if the people affected see the value and support it.?

• Maintain systematic review and adjustment: Once a solution is scaled, it still needs periodic review. The machine’s job doesn’t end with rollout; ongoing refinement based on real-world usage data is crucial for sustained success. Without a continuous improvement mindset, real progress will inevitably stall.??

• Guarantee leadership support: There will always be naysayers who try to slow down forward progress. They can often be found waiting at the elevator to the C-suite offices to “accidentally” run into senior leaders. Executives at the highest levels of the organization must support real innovation, even with the real possibility of failure.??

Overcoming the barriers to scale?

Let’s be clear: a scaling machine would demand both an operational and a cultural shift. The organization would need to move away from a mindset of isolated experiments and adopt one of coordinated, strategic growth. Leaders must ask themselves: is our caution benefiting us, or is it an excuse to avoid necessary risks??

In healthcare, there’s a persistent urge to wait for someone else to try it first. As a result, we end up five or ten years behind industries that have embraced similar tools to much greater effect. We should ask ourselves—what value are we really adding by waiting? Is it time to update our approach and treat innovation not as a risky proposition but as a necessary evolution??

The future of healthcare innovation?

Scaling isn’t easy, but stagnation isn’t an option. By setting up a systematic approach—a true scaling machine—we can turn promising pilots into wide-reaching, high-impact innovations. Imagine a world where innovative tools to support clinicians and improve patient outcomes are the standard, not the exception. This shift would help us fulfill our mission to deliver the best care while using resources effectively.?

It’s time to abandon our hobbyist approach to innovation and treat it as the vital, enterprise-wide priority it should be. Let’s stop “piloting” and start progressing!?