A lot of smoke and mirrors. The company hires individuals practically off the street, and sell their "experience" to hospitals as much more than what they are. The hospitals are often WAY overcharged. In many cases, the company is paying the employee as a program specialist, but are charging the hospital a program manager. In many cases, asking the employees to stretch the truth and even outright lie.
Furthermore, the maintenance and overall process of the rollout is tedious and often handcuffs the hospitals with an overwhelming about of maintenance. There are always space constraints and every hospital I was left in the dark by these contributing factors.
Some managers don't even have degrees.
Management is NOT open minded. Unless you're feeding there egos or talking about new ideas for the system, you won't be heard. Keep you're ideas to yourself. There's no skin in the game for adding value to the company, so I wouldn't share any new ideas.