We Don’t Need More Pilots That Fizzle Out Before They Fly 

Key Takeaways

• Many healthcare pilot programs fail to scale because they are not designed with operational alignment, stakeholder buy-in, and sustainability in mind from the outset.
• Scalable innovation requires early integration with clinical workflows, data systems, and reimbursement pathways that support long-term adoption.
• Workforce adaptation and trust-building among clinicians remain critical factors in successfully expanding new care models across health systems.
• Care redesign efforts must account for the realities of post-acute and home-based care, where health systems are responsible for outcomes but have limited control over patient environments.

In healthcare innovation, the word “pilot” has become a fixture, an easy placeholder for possibility. Yet all too often, pilot programs take flight without a real runway. They showcase potential but stall before they ever reach system-wide impact. It’s a familiar pattern: enthusiasm at launch, encouraging results, then inertia. Research suggests this isn’t the exception. According to Becker’s Hospital Review, citing the New England Journal of Medicine, 68% of digital‑health pilot initiatives never progress beyond the test phase.

What if the problem isn’t with piloting itself, but with how pilots are conceived and designed?

Moving from promising test cases to sustainable models requires deliberate design choices from the start. Based on our work with partners across healthcare systems, we’ve found that scale must be part of the blueprint from day one.

Why Promising Pilots Stall Out

Pilots often fail to spread for reasons that are entirely preventable. Some launch without clear alignment with a health system’s strategic or operational goals. Others overlook the need for frontline buy-in, designing workflows in isolation from those who would actually use them. Many lack the data infrastructure to demonstrate real-world effectiveness in a way that payers and administrators find compelling.

Based on our experience, successful pilots are grounded in structure from the outset, not driven by excitement alone. If implementation and sustainability are afterthoughts, even the most innovative ideas are unlikely to survive beyond the trial phase. 

What Scale-Ready Really Looks Like

Pilots designed for broader impact share several characteristics. First, they have a clearly defined problem to solve, one that stakeholders agree is urgent and actionable. They involve those stakeholders — clinicians, administrators, and patients — from day one.

Second, they are operationally integrated. That means building with existing electronic health records, aligning with staff capacity, and embedding evaluation metrics that match the system’s reporting needs. Data collection should be structured to both inform long-term decisions and demonstrate short-term successes.

Finally, these pilots are funded and structured with sustainability in mind. A promising initiative can lose momentum quickly if there’s no financial alignment, such as a path to reimbursement or cost savings. Our model looks for solutions that can survive beyond collaboration funding and serve as templates for replication.

Navigating Complexity Without Losing Vision

Innovation doesn’t have to mean starting from scratch. Some of the most scalable solutions are adaptations, refined to fit the contours of real-world practice. By collaborating with large health systems like Mass General Brigham, we focus on creating models that are both innovative and operationally feasible.

That means engaging clinical champions, understanding regulatory dynamics, and designing pilots that make sense not just in one department, but across diverse care settings. For example, through Duke Margolis, our Learning and Action Network is working with participating health systems to improve post-surgical care transitions and recovery after discharge. The goal is to reduce readmissions, emergency department visits, and unnecessary skilled nursing facility stays within the context of CMS accountable care models.

Scaling these efforts requires more than redesigning clinical workflows. Health systems must also build trust with clinicians adapting to new approaches and manage the complexity of supporting patients once they return home, where organizations remain responsible for outcomes but have less direct control over daily care decisions. Regular data reviews, coaching, and peer learning across participating organizations help teams refine these models and expand what works.

What to Ask Before the Next Pilot Takes Off

For health system leaders evaluating new pilot opportunities in 2026, a few key questions can make all the difference:

• Is the problem clearly defined and broadly acknowledged?
• Is solving this problem a system-level priority, or primarily a local service line issue?
• Are clinical and operational leaders involved in shaping the pilot?
• How will success be measured, and who decides what counts?
• What’s the plan for sustainability and scale if the pilot works?

In fact, 75% of health system executives report that their digital and analytics investments often miss expectations, highlighting the gap between early promise and enterprise-level success, according to McKinsey.

Sustainability also depends on a clear business case. Designing clinical and operational workflows is only part of the equation. Health systems must understand how money will flow once the pilot becomes part of routine care. That often means involving finance leaders early so reimbursement pathways, cost structures, and long-term operational viability are evaluated alongside the clinical model.

Moving from Proving to Scaling

Healthcare doesn’t need more poorly designed pilots. It needs meaningful efforts that are designed to learn fast and grow what works. We approach care redesign using rapid cycle tests of change. Teams try new approaches on a small scale, learn quickly from early results, iterate, and adjust before expanding to more patients and settings.

It’s time to intentionally design pilots as the beginning of something bigger. With the right foundation, they can be more than experiments. They can be the first step toward solving problems that result in a better future for older adults, providers, and the systems that serve them.