Building Digital Health Adoption From the Inside Out with Anniina Mustikkamaa
Anniina Mustikkamaa is a registered nurse, advanced life support paramedic, and project manager at Western Uusimaa Wellbeing Services County in Finland. She holds a master's in healthcare with a focus on global health and crisis management and a master's in public management. She has spent her career at the intersection of clinical practice and implementation, and she built a change management program from the ground up inside one of Finland's large public health and social care organizations, not by bringing in outside consultants but by taking people who already understood the system and turning them into the face of change.
The question her work keeps coming back to is the same one at the heart of everything Ardexia does: why do good implementations fail, and what does it actually take to make change stick?
Nobody Complains. Nobody Is Using It Either.
Quiet failure is one of the most common and least discussed patterns in digital health implementation. It does not announce itself. There is no moment of visible collapse, no dramatic pushback, no formal rejection. What happens instead is silence. Nobody complains. Nobody asks for help. Nobody sends a message saying this is not working. And so the assumption forms that things are going well, until someone looks at the numbers and realizes the change was never there. People went back to their old ways weeks ago and nobody said a word.
Anniina described this pattern directly: you poke around a little bit and you realize the change is not there. The silence was not satisfaction. It was the absence of engagement, which is a different and harder problem to solve because it gives you nothing to respond to.
The antidote is knowing what success looks like before you start, setting goals specific enough that you can measure against them, and being honest when the numbers are not what they are supposed to be. This sounds obvious and it is consistently not done. Healthcare is still learning to lead with data in implementation, to bring goal setting down from senior leadership to the people doing the day-to-day work, and to distinguish between a tool that has been deployed and a tool that has actually changed how people practice.
Building the Team From the Inside
When Western Uusimaa decided to implement a major health and social care platform, Anniina's team made a deliberate choice: the change management team would be built entirely from people already working inside the organization. Not outside consultants, not implementation specialists brought in from elsewhere, but nurses, physiotherapists, and social care workers who already knew the organization, already had networks, and already understood the day-to-day realities of the people they would be asking to change.
The practical logic was straightforward. Outside specialists bring frameworks and methodologies. Insiders bring credibility, relationships, and the kind of contextual knowledge that cannot be acquired quickly. When a first line manager is drowning in competing change initiatives and does not know who to call, they are far more likely to reach out to someone they have met, someone whose face they know, than to submit a ticket to an anonymous support queue.
What Anniina's team discovered along the way was something they had not fully anticipated: the organization was full of people with skills they were not using. Nurses with unused master's degrees. Clinicians who had trained in areas they could not practice in their day-to-day roles. The change management team became a career pathway as much as a project function, giving people an opportunity to apply education and capability that their clinical roles had never made room for. The position was heavily oversubscribed. They had far more strong applicants than they had expected.
That is worth pausing on. The talent was already there. It just needed a structure to activate it.
A Face to the Change
The operational model Anniina's team built around the concept of having a face to the change is one of the most transferable ideas in this conversation. Each person on the change management team owns a specific service line within the organization, from senior leadership down to the people doing the daily clinical work. That single person becomes the consistent point of contact across every stage of the implementation: the introductory conversations, the training sessions, the go-live support, the follow-up, and the ongoing improvement cycles.
The goal is that no matter where you sit in the organization, you know who to call. You have seen this person before. You have been trained by them. You know their face. And when something is not working or you are embarrassed to admit you do not know what you are supposed to be doing, the threshold for reaching out is lower because you are not sending a message into the void. You are contacting a specific person who has been showing up for you throughout the entire process.
This model does not scale infinitely and Anniina acknowledged that geographic dispersion creates real constraints. But where it is possible, the evidence for it is in the adoption numbers and in the quality of the support relationships it builds.
What Finland's Data Infrastructure Makes Possible
My first global digital innovation conference was in Finland in the winter of 2017. I was presenting on telemedicine, it was early for those conversations outside the US, and it was extremely cold. What I found more striking than the weather was learning how Finland had built national health data infrastructure that solved problems the US was still treating as intractable. Every citizen's health records accessible through a single portal. Prescriptions visible at any pharmacy in the country without the patient needing to carry anything. Full integration across public and private providers, across specialties, across the full arc of a person's care history.
That foundation changes what is possible in implementation. When clinicians and patients already expect digital services to work seamlessly, the bar for what a new tool needs to deliver is higher, but the resistance to digital change is lower because the category itself is already normalized. Anniina noted that citizen expectations have risen alongside the infrastructure, which creates both opportunity and pressure. Public healthcare in Finland is catching up to what banking and other sectors have already delivered digitally, and the expectation that it should is firmly established.
For implementation specifically, the single data environment means that integrations are cleaner, data sharing does not require negotiating between disconnected systems, and the question of whether a tool will connect to existing records has a more reliable answer. That is not a small thing. A significant portion of implementation friction in the US comes from data environment complexity that Finland has largely already solved.
Health and Social Care Together
Western Uusimaa covers both health and social care, which is not how most systems are organized and which creates a specific set of change management challenges that Anniina's experience illuminated clearly. Social care is different from healthcare in ways that matter for digital transformation. The core of social care work is face-to-face human interaction, meeting a person where they are, and that core can feel directly threatened by the move to digital platforms in a way that clinical healthcare work does not always experience in the same way.
Social care has also been underserved by the global development of health IT systems. Most platforms were built for healthcare and adapted, imperfectly, for social care. The assumptions baked into the systems do not always match the realities of social care workflows, which means the change management challenge is harder and the need for support is greater. Anniina was direct about this: change management is possibly even harder on the social care side, the systems are not yet as good, and the professionals working in that space need more support, not less, during transitions.
The lesson for any organization attempting to span both domains is that a unified change management approach will not serve both equally. Social care needs its own consideration, its own advocates on the change team, and its own honest accounting of where the tools fall short.
Quiet Success Looks Like Data
The same discipline that surfaces quiet failure is what confirms genuine success. Anniina's answer to the question of how you know an implementation has actually worked was unambiguous: data. Qualitative or quantitative, as long as you know what you are measuring, the evidence should be visible. Goals set before deployment. Numbers tracked through the process. Honest assessment of where things are moving and where they are not.
That preparation is harder than it sounds in organizations that are not yet accustomed to leading with data in implementation contexts. Setting specific numerical targets, bringing that goal-setting down from leadership to the people doing the work, and creating the feedback loops that surface both success and failure early enough to act on them: this is the unglamorous operational work that determines whether the investment in change management produces durable results or just an expensive go-live event that fades within months.
Principles for Healthcare Leaders
Quiet failure is the most common kind. If nobody is complaining it does not mean the change is sticking. Look at the numbers. Know what success looks like before you deploy so you can recognize failure when it arrives.
Build change management teams from the inside. Clinical colleagues who already have relationships, networks, and organizational knowledge will always be more effective than outside specialists who have to earn credibility while also delivering the program.
Give people a face to the change. A single consistent contact across the full lifecycle of an implementation lowers the threshold for asking for help and builds the kind of trust that sustains adoption past go-live.
Use implementation as a talent development opportunity. The people in your organization with unused education and skills are often your best change management candidates. Find them before you look outside.
Social care needs its own approach. Organizations that span health and social care cannot apply a single change management model to both. Social care has different relationships with digital tools, different workflow realities, and greater need for support during transitions.
Data is both the early warning system and the confirmation of success. Set goals before you start. Measure throughout. Bring the numbers down to the people doing the work, not just the people managing the project.
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Follow Anniina Mustikkamaa on LinkedIn
Related Resources
Episode 11 Why Most Digital Health Programs Never Cross the Threshold
Episode 10: The Gap Between Good Tech and Actually Using It with Stéphane Tholander
Article: 95% of Adoption Fails
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Dr. Aditi Joshi is the CEO of Ardexia and host of the Ardexia podcast. She's an emergency physician who has built multiple digital health programs across three continents and specializes in turning failed digital health implementations into measurable clinical and financial success.