At Trellis Heаlth, the prоduct mаnаger describes the patient-scheduling feature tо the business analyst in оne conversation, the analyst writes up a design a step removed from that conversation, and the developer implements from the design document without ever talking to the product manager directly. When the feature ships, it does something noticeably different from what the product manager originally had in mind — and different again from what patients actually needed. Nobody made an obvious mistake at any single handoff. What's really going on?