The Translation Gap - Why Good HealthTech Solutions Are Struggling to Thrive in Regulated Organizations—and Why Hardly Anyone Is Taking the Time to Change That

By Christian Schacht

Nothing had happened for three months.

A public health insurance provider had digitized its medical aids division. The concept was ready to go—technically sound, developed with a consulting firm that had done a thorough job. The software was up and running; IT had completed the technical rollout. On paper: everything was ready—HealthTech

Within the teams: a standstill. Employees continued to use the old methods. The project management was frustrated. The atmosphere was tense. And no one could say what the problem was.

When I joined the team, I spent two weeks doing nothing but immersing myself in the organization. One-on-one conversations with case workers, with team leaders, with the project management. No workshops, no slides, no diagnostic questionnaires. Just conversations. And above all: I listened first.

Those two weeks were the most important thing I could do in the program. Not because listening is some special discipline, but because this step wasn’t included in the project scope for any of the other stakeholders—and had therefore been left out until then.

The real problem isn't language, but the mission

It’s been described for years. On every panel, in every white paper. So the problem isn’t that nobody knows about them. The problem is that few take the time to embed them, as this translation requires.

Consulting firms are hired for concepts. IT service providers for implementation. Vendors for licenses. Training partners for training. Each of these assignments is clearly defined, output-oriented, and concludes with its own deliverable. What lies in between and beyond—the actual integration across the worlds of operations, compliance, management, IT, and vendors in day-to-day operations—requires a different timeline. It cannot be accomplished in a workshop or a training session during the go-live weekend. It takes weeks with no visible results at first, during which trust is built and new routines are established. In most program plans, this phase simply does not exist.

What didn’t work with the assistive technology program wasn’t that the consulting firm had done a poor job. The concept was sound. The IT was sound. What was missing wasn’t a lack of skill, but a gap in the project design—no one had been tasked with handling the translation. And so, no one did.

It is precisely this gap that is the reason why, after stints at Deloitte and PwC, I now work independently. At the big firms, I learned how to build concepts. What was hard to sell there was the work that goes on between the concepts and their impact. Today, I take on smaller engagements, without line-of-business interests, with the freedom to spend the first two weeks primarily listening and immersing myself.

Three questions I’ll be addressing in the first two weeks

Anyone who takes the translation challenge seriously won’t solve it with just one or two workshops. Workshops provide valuable in-depth knowledge but don’t ensure long-term results. What’s needed here is a different approach. In my experience, three questions determine whether a program will succeed:

For whom is the professional landscape shifting—and has this been explicitly acknowledged?

In every digital transformation initiative, there are people whose professional value is intertwined with the old processes. An experienced claims adjuster, whose judgment was recognized in manual processing, experiences a shift in the new process regarding where her expertise is needed—away from routine tasks and toward complex cases, exceptions, and advising policyholders. At its core, this shift is a promotion. But it only functions as such if it is explicitly communicated and jointly defined. If it remains unspoken, it turns into uncertainty—and uncertainty finds ways to slow down the program.

Where does the official narrative of the program diverge from the unofficial one?

In every project, there are two narratives: the one in the steering committee and the one in the cafeteria. If the two diverge, change won’t move forward—no matter how good the roadmap is. This discrepancy can only be identified below the committee level, in one-on-one conversations.

How will the organization know in six months that the change has taken hold?

This question forces us to be specific—something that is often missing from most program plans. Success is usually measured in go-live metrics: adoption rates, training completions, tickets per week. What constitutes a sustained change six months later remains unspoken. Yet that is precisely where it is decided whether a program has taken root—or whether it is merely recorded as a formal success and never becomes a lived reality.

These three questions do not constitute a complete methodology. But in the programs I see, they are the most common points where the translation fails.

What Happened Eight Months Later—and What Remains Unproven

Eight months later, the processing time for the assistive devices program had dropped to between two and four days. Previously, it had taken up to eleven. I am reluctant to cite this figure without providing context, as it sounds almost too neat.

It is impossible to cleanly isolate which specific factors—the software, the passage of time, the teams' learning process, or the ongoing support—were responsible for this outcome. The only indisputable fact is this: before the support intervention, the program was stalled; afterward, it was up and running.

2026: Why This Gap Is Becoming More Costly—Especially Now

In 2026, the healthcare system faces pressure unlike almost any it has seen before. Hospital reform is compelling institutions to make strategic decisions—decisions whose implementation demands significant organizational depth. The Electronic Patient Record (ePA) is currently rolling out, the telematics surcharge has expired, TI 2.0 is on the horizon, and the European Health Data Space is drawing near. On paper, the system is absorbing more digitalization than it has had to process in the entire preceding decade.

This carries an economic consequence: The "translation gap"—which, in stable times, manifests merely as a delay—becomes a structural risk during times of reform. Programs that fail to gain traction within organizations do not merely burn through investments; they also slow down the very reforms intended to safeguard patient care.

For HealthTech providers, this means the decisive competitive advantage is shifting. The determining factor is no longer simply who builds the best software, but rather whose software actually succeeds in gaining a foothold within regulated organizations. This constitutes a distinct discipline—one that, in the pricing models of most providers, remains structurally undervalued.

Where This Approach Does Not Work

I am describing experiences drawn from my own projects—this is not a representative sample. I am called in when programs stall; consequently, I systematically encounter the difficult cases. In the uncomplicated instances—where technology and organizational structure align well—no one even thinks to call me.

Moreover, this approach has clear limitations. In the case of acute crisis rollouts, extremely tight timelines, or organizations where psychological safety is lacking and honest conversations below the executive level are impossible, two weeks of listening simply will not suffice. Such situations require preparatory work—sometimes spanning months—before any reliable translation becomes possible. Anyone who ignores this is building on sand.

Conclusion

Three months of stagnation. Eight months later: a team that embraces the change as its own. In between lie no tools, no heroic narratives, and no single methodology. In between lies work—work that was never explicitly commissioned and, consequently, never got done—until someone arrived who was specifically tasked with doing it.

In the healthcare landscape of 2026, this work will prove decisive. Not because it is spectacular, but because, without it, the vast majority of the promises the industry is currently making cannot be fulfilled.

Anyone who fails to plan for this work—whether as a founder, investor, or client—is failing to plan the actual program itself.

Whoever does not plan it—whether as a founder, investor, or client—is not planning the actual program.