The Pilot Graveyard: Why BC's Health System Keeps Solving the Same Problems

 Written by Clare Koning RN, PhD | April 2026

Somewhere in a filing cabinet, or more likely a forgotten shared drive, there is a final report from a BC health innovation project that worked. Its outcomes were positive. Its participants were engaged. Its evaluation was rigorous. And when the funding ended, it ended.

This is not an unusual story. It is, in fact, the dominant story of health innovation in Canada.

A 2025 investigation into Canada's digital health innovation landscape concluded that promising tools routinely prove their value in pilot settings but cannot navigate the procurement, regulatory, and interoperability barriers needed to reach patients at scale, describing the country's health system as stuck in "pilot limbo," where innovation stalls between demonstration and deployment. Digital Journal

Globally, an alarming 80% of digital health solutions fail to transition from pilot to scale, typically due to the high costs and long development times that implementation at scale requires. HIT Consultant 

Canada's fragmented health governance, with each province managing its own systems, priorities, and procurement, amplifies this problem considerably.

Why Good Pilots Fail

The failure is rarely about the quality of the idea. It is almost always structural.

By diving deep into a specific problem within a single environment, innovators inadvertently create solutions that are over-indexed on local issues, calibrated to one team, one site, one set of workflows, making them ill-suited to replication even when evidence of effectiveness is strong. Medium

Healthcare professionals' reluctance to adopt new technologies stems not from ignorance but from legitimate concerns: unfamiliarity, perceived workflow disruptions, and patient safety considerations. A 2024 Canadian Physician and AI report found that 41% of healthcare providers expressed apprehension about using AI tools in clinical decision-making, and this resistance, coupled with insufficient training on integration, has materially slowed the expansion of digital health innovation across Canada. Digitalhealthcanada

Beyond adoption, there is the deeper problem of sustainability financing. Most health innovations are funded as research or demonstration projects. When the grant ends, the clinical team absorbs the work, if it survives at all, without the infrastructure, evaluation, or operational support that made the pilot function. The result is a version of the original innovation that is diluted, unsustainable, and eventually abandoned.

What the Ministry of Health's Own Service Plan Acknowledges

BC's Ministry of Health 2024–2026 Service Plan explicitly identifies complex and interconnected pressures requiring long-term, multi-year solutions, and acknowledges that the rapid advancement of technology creates both opportunity and risk, particularly around digital literacy, equitable access, and the limits of virtual care for those without technology or connectivity. Gov

This is a candid acknowledgement that the health system's challenges cannot be addressed by short-cycle responses. The policy logic that follows, though rarely stated directly, is that the organizations capable of driving sustained, system-integrated innovation are not the programs themselves. They are the intermediaries: organizations whose explicit mandate is to take what has been demonstrated and move it into permanent system practice.

Designing for Permanence From Day One

The most productive reframe available to health system leaders is this: stop evaluating health innovations primarily by their pilot outputs, and start evaluating them by their system integration outcomes.

Did this innovation become part of how the health system routinely operates? Did it survive the departure of its founding champion? Was it adapted for populations beyond the original pilot site, including rural, Indigenous, and lower-income communities who are often the last to access innovation benefits?

Answering these questions requires accountability frameworks that most pilot evaluation designs do not include. It requires organizations thinking in provincial, multi-year timescales. And it requires investment in the intermediary function, the connective tissue between a promising idea and the system that eventually absorbs it, as a standing budget line, not an afterthought.

The graveyard fills one report at a time. The alternative is not fewer innovations. It is a system designed, from the beginning, to keep the good ones alive.

IHSTS exists specifically to address the gap between pilot innovation and system integration in BC's health system. Learn more about our approach at www.ihsts.ca.