From pilots to system impact: What it takes to scale healthcare transformation

In my previous post, I reflected on why transformation in healthcare so often stalls despite real ambition and innovation. Here, I turn to the next challenge: scaling what works.

We talk a lot about transformation in healthcare. But what does it take to deliver it—consistently, across settings?

Over the past decade, I’ve worked with hospitals and health systems across Europe to support transformation in practice. And I’ve seen firsthand that the challenge is not innovation. It’s scale.

The real bottleneck is execution: the lack of infrastructure, coordination, and capacity to replicate what works beyond a pilot.

From scattered pilots to structured change

Health systems are full of creative energy—whether through digital triage, virtual care pilots, or outcome-based contracting. But too often, these efforts stay local. They don’t spread—not because they fail, but because we haven’t built the systems to scale them.

Three things tend to hold us back:

1. Fragmentation — Care is delivered in silos, with different systems, incentives, and priorities. The wheel keeps being reinvented—similar solutions built again and again instead of shared and scaled.
2. Limited delivery capacity — Many institutions lack the people, tools, or support needed to turn intent into sustained change.
3. Policy misalignment — Funding and procurement frameworks often reward volume and status quo, not innovation or transformation.

What enables scale?

In my experience, six enablers consistently make a difference:

1. Shared frameworks — Clear clinical, operational, and digital standards that align efforts across settings. They enable coherence between actors, ease transferability, and reduce the need to reinvent the wheel.
2. Embedded delivery capacity — Dedicated transformation teams — whether internal or supported by partners — that bridge the gap between strategy and execution. Without this layer, ambition can’t become action.
3. Long-term partnerships — Deep collaboration between providers, industry, and system actors — focused on outcomes, not transactions. They enable co-investment, long-range planning, and joint accountability for transformation impact.
4. Distributed innovation — Developing in parallel across different contexts and care pathways, while remaining guided by shared transformation principles. This accelerates learning and helps systems scale what works with speed.
5. Data and evidence backbone — Integrated digital platforms and real-world evidence to drive trust, clinical adoption, and policymaker support. Transformation spreads through proof.

6. Aligned financial models — Incentives that reward outcomes, and mechanisms that reinvest system savings into further transformation. Without economic sustainability, progress stalls.

These enablers don’t require radical reinvention. But they do require intentional design, political will, and a willingness to move beyond institutional silos.

Why collaboration matters

No single actor can deliver this alone. Providers bring grounded insight and frontline credibility. Policymakers can create incentives and remove barriers. And industry—when engaged as a strategic partner—can contribute infrastructure, capacity, and cross-system perspective.

This is where initiatives like Care Beyond the Hospital Walls come in — a program designed to connect providers, researchers, and companies around shared transformation clusters.
Its modular structure allows multiple care models to emerge in parallel — from ambulatory surgery to hybrid chronic care — while remaining aligned through a common platform.

We need more of this. Not one-off pilots, but delivery ecosystems that allow health systems to move faster, more consistently, and with less duplication.

Looking ahead

As we establish the new Sector Committee on Healthcare System Transformation, my hope is that it becomes a space to align on what works, share lessons from the field, and tackle barriers together.

The debate is no longer about whether change is needed — but how we deliver it, at scale, and with staying power.

This is our opportunity to turn collective insight into system-level progress.