"The emperor's new clothes": a qualitative study of end users' experiences from a failed large-scale implementation...

Electronic health records (EHRs) play a vital role in healthcare organizations to manage patients' health information. Implementing or transitioning to EHRs is often a large-scale implementation with many challenges. Organizational and individual readiness is crucial for successful adoption and implementation of an EHR system. The objective of this study was to explore clinicians' and administrative staff's experiences of a large-scale EHR implementation (Millennium) that was terminated shortly after its initial deployment.

A qualitative design involving individual online interviews with 73 clinicians and staff investigated end users' experiences after a large-scale implementation of EHRs in Sweden. A semi-structured interview guide was used during the interviews and included broad questions on individual and collective readiness to change before, during and after the implementation. Interviews were recorded and transcribed. The data were analysed using reflexive thematic analysis.

The findings show that experiences from a failed implementation highlight inadequate communication with the management level, inadequate preparedness in understanding the change and education on how to use the system. The results also show that the end users felt deceived, disappointed and overwhelmed with stress. End users highlighted the need to be involved in the implementation process and understand the whole picture. Lack of dialogue and feedback between co-workers and top management negatively affected organizational and individual readiness. Incomplete readiness and system contributed to anxiety, feelings of abandonment and being in an abstract reality.

The findings provide an empirically grounded account of a failed large-scale implementation, reinforcing and extending key insights from implementation science. The study underscores that implementation is inherently a socio-organizational process, where meaningful end-user involvement and continuous, bidirectional communication between frontline staff and management are not peripheral but constitutive conditions for successful change. Anchored in Organizational Readiness for Change, the findings illustrate how limited readiness, combined with misalignment between system design and local context, can drive non-adoption and rapid abandonment. The system's positioning as a comprehensive, modern solution raised expectations that were not met in practice, resulting in a sense of emptiness and disappointment among the participants, echoing the tale of the emperor's new clothes.