Working on the vendor side, I delivered the same software to organizations that got very different results from it. The product was not the variable. The consequences were.

In most implementations I delivered, the project lived inside IT. The business case justified the purchase, then went into a drawer. Department leaders showed up for demos, signed off on timelines, and reappeared at go-live to ask why things looked different. The project team carried the weight, and when adoption lagged, it was treated as a training problem. The executives who approved the spend were rarely the ones accountable for the return. The most commonly blamed party was the vendor. Their poor implementation was why adoption struggled. It was not the whole story.

One agency did it differently

One deployment I still think about started before anyone touched a configuration screen. It was a large private-duty agency where the new executive team had come from outside the market. The CEO brought the entire executive team into a room and told them this was their project. That alone put it in rare company. Most implementations never get executive attention outside of IT, and the departments that are never consulted end up quietly working against the project.

Then leadership went further. They tied a portion of the executive bonus to the deployment and measured it against the return that had been used to justify buying the software in the first place. Every executive in the bonus program carried it, not only the ones with clinical staff reporting to them. Teams that owned a specific part of the ROI had that number in their comp plan. Everyone carried the overall ROI goal. The business case stopped being a procurement document and became a scorecard.

Once the executives were accountable, they brought their own departments along. The work of getting people on board moved out of the project team and into the organization, where it belonged.

Executive sponsorship did not replace the project work. It changed the conditions the project work happened under. The difference was visible from the vendor side. The teamwork was better. Everyone was more engaged, and deliverables got completed faster. When decisions needed to be made or problems came up, leaders leaned into them instead of letting them sit. Change management was more effective because each team knew where the project stood and how their users were doing. They were part of the project, not spectators.

Executives showed up more. In many implementations, you get every executive at the kickoff and at the “it failed, let’s recover it” meeting. At this agency, they were not at every meeting, but they all showed up for the milestone approvals in between. More importantly, they stayed engaged after go-live, which is where the ROI actually happens. They drove the sustained organizational change needed to hit the numbers they had approved.

Sign-off is not ownership

Everyone signs off on the ROI case, because everyone wants the new software. Far fewer are willing to put their own compensation behind the numbers they approved. That gap is where most implementations are decided.

When your organization approved its last EHR investment, who was measured on whether it delivered the return that justified buying it?

I spent nearly three decades at Netsmart and Allscripts delivering these implementations. The difference between the ones that stuck and the ones that stalled was rarely the software. If your organization is planning a deployment and you want to talk through how to structure the project for long-term success, I’m happy to have that conversation, feel free to reach out:

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