That contradiction sits at the heart of research into digital transformation in healthcare by Prof. Elizabeth Regan of the University of South Carolina and her colleagues. Prof. Regan’s research is focused on providing better care by seeing the whole system, and by recognising that the people closest to its problems are essential participants in designing new approaches. It treats transformation as a process of collective problem solving. Rather than beginning with a predetermined technology, successful organisations begin with a clearly defined problem and a desired improvement in patient care. They involve the people who encounter the problem every day, including clinicians, patients, managers and technical specialists, and allow the solution to develop through repeated testing and refinement.

Instead of asking which new tool a hospital should buy, we might ask what problem patients and clinicians are actually experiencing, why that problem persists, and how technology could help redesign the way care is delivered. That sounds like a subtle shift, but it has radical consequences. A shiny digital platform layered onto a confusing process can simply produce a more expensive digital version of the same confusion.

Healthcare is especially vulnerable to this problem because it is fragmented and complex. Care is delivered across hospitals, clinics, laboratories, pharmacies, specialists, insurers, public agencies and other organisations. These groups depend on one another, yet they often operate according to different incentives, routines, information systems and professional cultures. A patient experiences one continuous health journey, but the organisations serving that patient may experience only separate episodes.

Prof. Elizabeth Regan’s strongest message is change the research paradigm itself. If society wants research to solve complex real-world problems, then researchers need room to work across disciplines, collaborate with frontline practitioners, revise ideas in response to evidence and remain engaged long enough to see whether changes survive. Funding systems must recognise that transformational research can take years and that understanding the problem is itself part of the research.

Controlled studies, hypothesis testing and specialised expertise all remain indispensable. The argument is that they are not sufficient for every question. Determining whether a treatment works is different from discovering how thousands of people, technologies and organisations can reliably deliver effective care. The second problem demands knowledge from medicine, engineering, information technology, behavioural science, organisational change and other fields. It also demands cooperation between researchers and the people who deliver and receive care.

This helps explain why enormous investment in digital health has not produced transformation everywhere. In research examining more than a thousand US hospital systems, only a minority had reached the level of digital maturity needed to provide strongly digitally enabled services. Crucially, the systems that had advanced further also showed better patient outcomes. The lesson is that digital technology can be enormously powerful, but its benefits depend on how deeply and smoothly it is woven into the real work of care.

That means redesigning workflows, responsibilities and relationships rather than merely installing equipment or software. It can mean ensuring that information follows a patient across organisational boundaries. It can mean changing how teams communicate, how clinicians receive useful information and how patients participate in decisions. It can also require leaders to confront habits and assumptions that have been embedded in institutions for years.

One of the most important assumptions concerns what it means to be patient-centered. The phrase is now so familiar that it risks sounding automatic, as though healthcare becomes patient-centered simply by declaring that patients matter. Regan’s research suggests something more demanding. A genuinely patient-centered system is organised around the patient’s needs and journey rather than around the convenience and boundaries of providers.

Consider how different a hospital looks depending on where you stand. To staff, a ward may feel relentlessly busy. To a patient lying in a bed, the same ward may contain long stretches of uncertainty, isolation and waiting. Similarly, a sequence of appointments that makes administrative sense to separate departments may force a sick person to travel repeatedly between buildings, floors and services. From inside each department, the process can appear reasonable. From the patient’s perspective, the combined experience can look absurd.

Seeing care through patients’ eyes therefore becomes more than an exercise in courtesy. It is a method for discovering problems that institutions may otherwise fail to notice. Successful transformation efforts have brought clinicians, managers, technical specialists and patients closer to the frontline experience, asking them to examine how care actually unfolds rather than how organisational charts suggest it unfolds.

This is where Dr. Regan’s distinction of working on the healthcare system, rather than simply working in it, becomes powerful. Medical research traditionally asks vital questions about disease, diagnosis and treatment. Healthcare delivery science asks another set of questions: how can proven knowledge, skilled professionals and useful technologies be organised so that patients reliably receive the benefits?

The distinction reveals an uncomfortable truth. A system can contain excellent doctors, excellent nurses, excellent researchers and excellent technologies without producing excellent care as a whole. Complexity means outcomes emerge from interactions among many parts. Improving one part in isolation may do little, or may even create new difficulties elsewhere.

This approach may seem less tidy than the traditional model in which researchers design an intervention, test it and then hand it over for implementation. But healthcare rarely behaves like a laboratory. A change in one workflow can affect several departments. A new digital tool can alter professional responsibilities. An apparently efficient process for one group can create extra work for another. Even a technically excellent system may fail if clinicians do not trust it, understand it or see how it improves care.

That is why design science is so relevant. Instead of treating users as the final recipients of an innovation, design-oriented research brings them into the process of understanding the problem and creating the response. Solutions can be tested in real settings, evaluated, adjusted and tested again. The aim is to make rigorous inquiry better suited to complex problems whose solutions cannot be fully specified in advance.

Technology then assumes a more realistic role. Electronic health records, information exchanges and artificial intelligence can help information travel, reveal patterns and support decisions. Yet they are enablers rather than solutions in themselves. Their value emerges when they help people achieve a meaningful goal, such as reducing errors, coordinating treatment or giving patients greater control over their care. Starting with the technology risks producing impressive capabilities in search of a problem. Starting with the problem asks what capabilities are actually needed.

Transformation also depends on committed leadership. The researchers examined healthcare organisations that achieved unusually strong results and showed that committed executive leadership was critical in communicating the objectives for change and how it would lead to goals for better care. Regan likes to characterize it as painting the picture on top of the puzzle box to help everyone better see how the puzzle pieces intersect. Leaders had to remain actively engaged over many years, support difficult changes, overcome resistance and keep attention focused on patient outcomes. Genuine transformation can challenge established routines, professional identities and organisational interests. It therefore requires persistence as well as vision.

Time matters for another reason. Deep transformation does not involve a perfectly predictable destination. The future system cannot always be described completely at the beginning because people learn while changing it. New problems appear, assumptions are challenged and solutions evolve. Research methods and funding structures built around short, tightly controlled projects can struggle with this reality.

The broader lesson reaches beyond hospitals. Many of society’s most intractable challenges are systems problems. Climate adaptation, public services, education and infrastructure all involve technologies embedded in institutions, cultures and human behaviour. In such settings, improving isolated components does not guarantee that the whole will improve. Research aimed at societal transformation may therefore need to become more collaborative, iterative and grounded in the places where problems are actually experienced.

For healthcare, the stakes are intensely personal. Day-to-day, patients experience whether somebody has their information, whether appointments connect logically, whether instructions make sense, whether mistakes are prevented and whether they feel that care has been organised around their needs.

Digital transformation succeeds when those experiences improve. The most sophisticated technology in the world cannot substitute for a system designed to use it well. But when technology is combined with patient-centered thinking, frontline knowledge, committed leadership and research capable of learning from complexity, it can become a powerful catalyst for change.

Dr. Regan’s research offers significant evidence to show that achieving digital transformation requires substantially different approaches than typical technology implementation and change management methodologies. Her research explores these differences with the aim of determining how approaches differ, why the differences matter, and implications for achieving better results.

The healthcare revolution, then, may depend less on inventing another dazzling tool than on learning how to effectively leverage digital technologies to share information, redesign care processes, and coordinate care across our exceedingly complex healthcare delivery system. The real breakthrough is to stop treating fragmentation as inevitable and start designing healthcare as a connected system that is essential for better coordinated patient care.