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Grace Bourke, Consulting Director at Baker Tilly, has spent nearly four decades working at the intersection of healthcare, quality improvement, and technology. She joins Jamie Flinchbaugh in this episode of People Solve Problems. She shares what she has learned about why technology implementations so often go wrong, and what organizations can do to get ahead of the problems before they take hold.
Grace opens with a fundamental challenge: organizations frequently deploy technology without fully understanding the problem they are trying to solve. At Sutter Health, she saw teams convinced that a new electronic health record system would resolve issues that were actually rooted in communication gaps and unclear standard work. The danger, she explains, is that technology does not eliminate underlying problems. It simply makes the mistakes happen faster and harder to trace once they are buried in a database.
To address this, Grace uses an approach she calls Gap-IT, a structured gap analysis that maps how work is currently done against how it will function in the new system. In one example involving a Pacific Northwest health system undergoing an ERP reimplementation, the process revealed that roughly half of the desired improvements could be made immediately, before the technology ever went live. The other half genuinely required the new platform. Her takeaway: stable processes and the technology designed to support them have to develop together.
On the question of buy-in, Grace draws a useful distinction. When a technology change is non-negotiable, such as when a platform has aged beyond maintenance, people do not need to agree with the decision. But they do need to be invested in making the transition succeed. She argues this requires two layers of communication: senior leadership setting the vision and the why, and trusted voices closer to the front line delivering the messages that affect individual roles and responsibilities directly.
A central tool in Grace's approach is Failure Mode and Effect Analysis, known as FMEA. Her team adapted it specifically for healthcare, condensing it to a half-page card that staff completed, then passed to a colleague for independent validation. That handoff was intentional: it prevented the tendency to simply defer to whoever wrote the card and created a shared responsibility for accuracy. Beyond its risk management function, the practice had a quieter effect. Grace recalls receiving a text from a participant who thanked her for helping her find her voice, because the format gave people a structured, safe way to speak up and stand behind their thinking.
This leads to one of the episode's most direct observations: healthcare remains deeply hierarchical, and that hierarchy consistently strips agency from the people best positioned to spot and solve problems. Grace points to Toyota's model as a counterexample, where every person on the floor is expected to be both a problem spotter and a problem solver. In her own experience, frontline staff flourish when given clear boundaries within which they have real authority to act. The obstacle, she notes, is that it takes consistent leadership to hold that space open.
Grace closes with the priority framework that has guided her throughout her career: safety first, then quality, then delivery, then cost. In healthcare, she says, the order is not just a preference. It is the whole point.
To connect with Grace Bourke and learn more about her work at Baker Tilly, visit www.bakertilly.com or find her on LinkedIn at www.linkedin.com/in/gracebourke.
