Many times, we can certainly report on the outcomes, but the real issues lie well beyond usability testing. Case in point, medication compliance. For the last 4 years, I have been looking at medication compliance. Many companies want to create better packaging, reminders or systems that will remind patients to take their medication. So often, there are extenuating circumstances at play. No reminder, no matter how large, loud or persistent can make a patient take his/her medication.
What pharmaceutical companies don't usually want to hear is that there are larger issues at play. Side effects: What about all those medications that make you dizzy, nauseous, cause anal leakage, loss of libido and perhaps a rash. Great! At least your depression will go away and you won't care about these side effects!
Finances: It's no surprise, more and more people are without health insurance. Yes, you can juggle your finances to a point, but the cost of medication is often not seen as a critical expense (though it very well may be.) However, without food for sustenance and a roof over your head, the medication can be rendered useless anyway.
Medical literacy: A patient decides s/he can handle the side-effects and has money for the medication. The patient nods and smiles as the doctor and then the pharmacist explain the best way to take the medication. At home, later that day, those memories are gone and the patient is faced with a pill bottle or jar with limited instructions. The patient then begins taking the medication to the best of his/her memory, but forgets or doesn't understand the small print labels on the bottle. Patients often take their medications out of the pharmacy bottle so the directions are nowhere in sight. Meanwhile, the patient has decided on a routine that is not optimal for medication delivery.
These are just a few of the larger issues which significantly effect medication compliance. But medication compliance is just a sample problem to illustrate a point. We need to talk with our co-workers and clients, people who design and sell products and services and be sure we are all spending our time and money asking the right questions, not just the questions in the budget line. Usability testing can be "lipstick on a pig" providing changes to an already broken product or service, or it can provide significant insights to adaptation and acceptance of the right product or service.