BPM in Theory vs. Reality: Why Your Platform Isn't Living Up to Expectations

BPM Implementation: Why "Readymade" Solutions Often Miss the Mark

When insurers buy a BPM platform like Pega, there is a pervasive assumption: the software will come ready to use, streamlining operations and transforming workflows overnight.

But there is a key UX insight we often miss: what users say they do and what they actually do are two very different things.

Here is a real-world example from a study we did with claim processing agents at a leading US health insurance company, primarily serving Medicaid and Medicare.

• Agent A insisted she relied on the Pega case management flow, but in reality, she kept her own manual notes on the side. Because the official process was unreliable and forced repeated data entry, she spent time on duplicate admin instead of processing claims.
• Agent B said her workflow followed the standard path, but observation revealed numerous phone calls, emails, and backtrack steps just to keep cases moving. Once cases were routed forward, visibility was poor and she fell back on her own tracking methods.

Both asked for fewer steps and better notifications, but their actual behavior exposed something more fundamental.

• Broken trust in the tool itself.
• Inefficient workarounds to deal with bottlenecks.
• Design that did not match their daily reality.

Key Takeaways for BPM Implementations

• Watch, do not just ask: To maximise your Pega implementation, shadow users and observe actual workflows.
• Workarounds are red flags: Every manual note or phone call signals a gap in platform capability.
• Design for reality: Solve the problems people actually face, not just the ones teams assumed existed.

Have you seen this gap between sold functionality and actual use in your BPM rollout? How did your team resolve it?