Over the last few decades, we have seen a recurrent theme: most software projects fail and these failures cost businesses billions in annual revenues. Testing is a key factor contributing to this failure and test automation is viewed as the silver bullet to resolving inadequate, flawed testing. But the result has only been increased speed to failure. There is pressure for testing to predominantly focus on automated coding instead of testing as a whole—manual and automated. Sound manual test cases are drivers of success behind test automation. Test automation develops code based on these test case inputs and, therefore, can only be as good as the quality of the manual test cases. We present highly successful user-focused software testing innovation case study with a proven 4 year success in software automation for a leading healthcare desktop application. We are in the process of applying this innovation to our healthcare mobile and web-based applications. This innovation leverages the best practices in the international quality assurance community, the ISTQB: manual test case design as the foundation of successful automated testing. In addition, we have developed a test automation environment for QA engineers and development that enables and empowers manual testers to significantly improve the quality of testing and facilitate successful test automation. The end result is improved application quality through improved testing—improved usability and user experience. Very simply, less defects and more satisfied users.