When a DSO buys a new platform, the celebration happens at signing. The pain happens at month four, when the system is technically live but the team is still booking patients in the old workflow. By month eight, ROI projections are quietly retired. By year one, the contract renewal becomes a conversation about whether to keep paying for something nobody fully uses.
We've sat inside this story at vendors, DSOs, and PE-backed platforms. The failure points are almost always the same five.
1. No one owns the outcome
The vendor owns the install. The DSO ops team owns "rollout." The office managers own "training." Nobody owns adoption. When everyone is responsible, no one is — and the first real friction stops the whole project.
2. The handoff happens too early
Vendor implementation teams are measured on go-live, not on usage. So once the system is technically running, they're gone — usually right at the moment the office actually needs the most support. The gap between go-live and real adoption is where most value evaporates.
3. Workflows weren't redesigned
Buying new software and running old workflows on top of it is the most common DSO mistake we see. The software is built for a different operating model. Without redesigning the workflow first, the team reverts to workarounds within weeks.
4. Change management is treated as training
Sending out a Loom video is not change management. Change management is rebuilding habits, accountability, and incentives so that doing the new thing is easier than doing the old thing. This is operational work, not communications work.
5. There's no measurement system
If you can't see who's using the platform, who isn't, and what specific friction is in their way — you can't fix it. Most DSOs go live with no adoption dashboard at all.
Adoption is not a phase. It is the only outcome that matters.
None of these are technology problems. They're operating-model problems. Which is why bolting more technology on top doesn't fix them — and why the implementation leg is where every dollar of tech ROI actually gets made or lost.