SUMMARY:While healthcare leaders increasingly recognize that workforce well-being matters, many organizations still approach wellness with a focus on programs and benefits housed within human resources (HR). These initiatives frequently appear misaligned with the clinical realities that clinicians face and are insufficient in addressing the underlying drivers of burnout. This often leads to efforts that generate activity but have little long-term effect.Healthcare organizations could never manage quality and safety through isolated departmental efforts; instead, a similar, unified approach is required for workforce well-being. Quality and safety initiatives are treated as shared organizational responsibilities and tailored to specific roles and environments. Workforce well-being demands the same discipline. When strategies are siloed and "owned" separately by different departments-e.g., HR, nursing leadership, physician groups, or individual units-they risk duplication, inconsistency, and misalignment with daily work.A unified approach does not imply uniformity. Instead, it creates shared governance, common goals, and expectations while allowing for role-specific tailoring. A busy nurse may benefit from a brief, five-minute intervention embedded in the workflow, while another role may require more in-depth training, such as a half-day workshop. Both approaches can be appropriate when guided by a common framework and aligned with organizational goalsUsing the National Academy of Medicine (NAM) clinician well-being framework as a starting point, this article examines how national guidance can be translated into an actionable, systems-level strategy. We also introduce a Four Pillars approach as an organizational translation of the NAM guidance, providing leaders with a roadmap for moving beyond fragmented wellness efforts toward coordinated, sustainable action.
SUMMARY:North Carolina's (NC) healthcare workforce shortages have been a major concern, as geographic health disparities become more pronounced and health outcomes decline in rural communities compared to those in urban areas. Rural residents face severe challenges accessing primary and specialized care and behavioral health services, especially in counties designated as Health Professionals Shortage Areas (HPSAs). NC will continue to experience these challenges as its overall population grows.Historically, NC had to pivot and reimagine policies and programs to improve its workforce crisis with federal assistance. Medicaid expansion and transformation, provider incentives, international labor recruitment, and innovative federal funding sources helped mitigate critical provider gaps and enhance access to care. However, in the wake of state budget challenges and fiscal restraints, persistent provider differentials remain.This article discusses how federal assistance has impacted the rural healthcare workforce crisis in North Carolina prior to the passage of the H.R.1 One Big Beautiful Bill Act (OBBBA) of 2025 (Congress.gov 2025). It also examines OBBBA's policy provisions and NC's plan for workforce improvements with the $213 million funding awarded through the Rural Health Transformation Program.
SUMMARY:This article explores allied health professionals in light of persistent and increasing workforce shortages in multiple healthcare roles, along with the growing demand for services, adapting to technological advancements, and evolving patient expectations. While expectations for access, experience, and value increase, the national projections indicate an uneven availability of physicians and nurses. Vanderbilt Health's allied health professionals are a reliable and important asset in the delivery of care and represent a key workforce strategy for health systems. They are also in short supply.Allied health professionals-including respiratory therapists, radiology technologists, rehabilitation therapists, neurodiagnostic technicians, speech language pathologists, medical laboratory scientists, and others-are critical, as physician and nursing shortages increase. Training pipelines, credentialing reforms, and retention strategies can ensure these specialists are adequately resourced to support patient care. Our allied health partners provide extensive patient interaction, supporting care plans when nursing resources are stretched thin.
SUMMARY:Healthcare organizations operate amid persistent complexity, yet the success of strategy, transformation, and performance ultimately depends on workforce engagement, trust, and alignment with purpose. This article examines the partnership between the CEO and chief human resources officer (CHRO) as a critical, yet often underleveraged, driver of organizational effectiveness in healthcare, and how the CHRO can serve as a strategic partner to the CEO for navigating disruption and sustaining performance.Using real-world examples from periods of significant change at Virtua Health, the article outlines six practices that strengthen the CEO-CHRO partnership: (1) embracing constructive discomfort and candid dialogue, (2) ensuring direct access and alignment between the CEO and CHRO, (3) extending trust into the boardroom, (4) treating employee listening as operational intelligence, (5) investing in long-term workforce pathways rather than short-term staffing needs, (6) and leading with adaptability rather than command-and-control authority. Central to these practices is recognizing the CHRO as the organization's "chief culture champion," uniquely positioned to interpret workforce data, translate strategy into behavior, and steward shared values.The article concludes that the rapport between the CEO and CHRO materially shapes how change is experienced-either as purposeful progress or uninformed, imposed disruption. In healthcare, where human connection underpins quality, safety, and access, this partnership is a catalyst for workforce resilience and organizational performance. Strengthening the CEO-CHRO partnership represents one of the most practical and impactful levers available to healthcare leaders confronting today's challenges and future uncertainty.
SUMMARY:Rural hospitals across the United States face growing financial and operational pressures, with many at risk of closure due to workforce shortages, aging infrastructure, and limited access to capital. In response, many rural healthcare organizations are exploring strategic affiliations with larger health systems as a pathway to long-term sustainability. In January 2021, St. Lawrence Health, a three-hospital system serving a geographically large and medically underserved region in northern New York, formally affiliated with Rochester Regional Health.This article examines the experience of integrating a rural health system into a larger regional network and highlights key outcomes, challenges, and lessons learned. At the same time, the integration process presented important challenges common to rural health system affiliations. Geographic distance between organizations, integration during the COVID-19 pandemic, differences in labor environments between unionized and non-unionized workforces, and concerns about community identity required thoughtful leadership and sustained engagement.The experience of St. Lawrence Health provides a practical example of how system affiliation can support rural healthcare delivery while also revealing the operational, cultural, and workforce complexities that accompany rural-urban health system integration.
SUMMARY:Senior leaders in medicine frequently rely on formal organizational charts as strategy roadmaps, overlooking the critical role of informal networks and their social capital to drive organizational change. The disconnect between formal and informal structures is especially problematic during times of uncertainty when change is required, such as after a merger or major acquisition, in response to evolving market forces, or due to an unanticipated external event like the pandemic.Tools such as the Balanced Scorecard can bridge this gap by aligning decentralized units with enterprise goals. Such systems create understanding and commitment among all unit employees about how their skills and competencies can contribute to a common purpose. Successful institutions mobilize informal leaders early during periods of uncertainty, empowering clinicians and staff to innovate and collaborate beyond job descriptions and departmental boundaries. In this article, we present two case studies on how such an approach works in a crisis environment.
SUMMARY:Healthcare leaders face sustained uncertainty: workforce volatility, financial pressure, and accelerating technology change. In 2024-2025, Ardent Health advanced an AI-enabled virtual care model from pilot to production across multiple markets. The model integrates virtual nursing, virtual attending physicians and providers, virtual sitting, and hospital-to-home remote patient monitoring (RPM) into routine care, with artificial intelligence (AI), providing earlier risk detection and workflow relief. Specifically, AI systems (1) analyze video streams to detect fall risks and unsafe behaviors, prompting earlier alerts to staff; (2) continuously evaluate vital sign trends from wearable sensors to identify clinical deterioration sooner; and (3) support ambient documentation with speech recognition and natural language processing (NLP) that improves note quality and coding accuracy.At Ardent's East Texas location, five months of virtual nursing contributed to reductions in contract labor, a decrease in voluntary RN turnover, and improvements in salaries, wages, and benefits (SWB) per patient day despite an increase in volume. Meanwhile, virtual attending physicians and providers increased virtual patient consultations resulting in patient retention and, generated bed-day capacity; AI-assisted vitals monitoring correlated with lower mortality and shorter length of stay; and the RPM program improved discharge continuity and avoided readmissions.This article presents a case study and playbook to help leaders manage risk, scale safely, and measure value. Readiness includes updating consent form language; data-use and retention policies; training staff to obtain patient consent; establishing algorithm oversight with internal data, analytics, and data science capabilities; and investing in network, data center, and hardware upgrades. We close with lessons learned and an organizational performance tracking accountability structure.
SUMMARY:In a time of dramatic change on multiple fronts, health systems must evolve with a mindset of persistent flexibility, where change is treated as normal rather than episodic or exceptional. At BJC Health (BJC), one of the nation's largest nonprofit health systems, treating patients in Illinois, Missouri, and Kansas, our change leadership approach emphasizes deliberate planning, leadership development, and communication to drive acceptance, ability, and accountability.This article describes two use cases that draw on this discipline: (1) the integration of employee benefits following the merger of BJC and Saint Luke's Health System, which required careful stakeholder engagement, extensive leader training, and transparent communication to address employee anxiety while maintaining operational stability; and (2) the implementation of artificial intelligence aimed at reducing administrative burden, improving provider well-being, and enhancing patient care. In both cases, success depended not only on the quality of solutions but on leaders' ability to guide people through change.By investing in change leadership capabilities, BJC has established a consistent and sustainable process for minimizing disruption, preserving our culture, and positioning ourselves to thrive amid continual transformation.
SUMMARY:Healthcare leaders today face a landscape defined by policy shifts and financial volatility. The impending implementation of the H.R.1 One Big Beautiful Bill Act (OBBBA) and the associated reduction in federal spending present a critical challenge for safety-net providers and payers alike. This article offers a strategic framework for managing this change, drawing on insights from leaders across the payer, provider, and philanthropic sectors. We explore strategies to mitigate coverage loss through targeted outreach, examine how Federally Qualified Health Centers (FQHCs) and Certified Community Behavioral Health Clinics (CCBHCs) must operationalize community health for their survival, and analyze the risks to the broader healthcare delivery system. Finally, we recommend practical leadership approaches to maintain workforce resilience and advocate for systemic sustainability.
SUMMARY:In 2012, Alegent Health and Creighton University entered a transformational affiliation that merged a large community-based health system with a century-old academic medical institution. Although strategically promising, the alignment introduced significant cultural, operational, and mission-related challenges. Clinicians, educators, and leaders struggled to reconcile differing expectations, professional identities, and organizational norms. The resulting uncertainty intensified mission misalignment, emotional resistance, and leadership fatigue.This case study examines how communication-grounded in principles of trust and transparency-served as a foundational leadership strategy for navigating this complexity. Rather than relying solely on structural reorganization, leaders used intentional, multidirectional communication to reduce uncertainty, foster alignment, and rebuild trust. Drawing on lessons from the Alegent-Creighton academic integration, this case study offers practical insights for healthcare leaders navigating large-scale transformation amid sustained uncertainty.
Healthcare spending in the United States continues to rise as patient demand shows no signs of slowing. In response, health system executives have invested billions in technology modernization to boost efficiency and reduce costs through automation, such as machine learning models, generative AI models, deep learning models, and others. These efforts have improved access, enhanced outcomes, and standardized patient data collection, fueling advances in research and the development of future treatments. Now, the industry stands at a pivotal moment: how to responsibly leverage years of patient and outcomes data to train artificial intelligence (AI) to generate return on investment (ROI) through data monetization, accelerate care delivery, and lower costs while managing the risks and unintended consequences of IT adoption. This article explores how AI and other emerging technologies in healthcare demand critical evaluation of responsible data use, careful consideration of data privacy and compliance, and clear strategies for measuring the positive or negative unforeseen consequences of AI across different stakeholders.
The One Big Beautiful Bill Act (OBBBA) contains $1.3 trillion cuts in funding to federal healthcare programs—including $1 trillion cuts to Medicaid and $300 billion cuts to the Supplemental Nutrition Assistance Program (SNAP)—mandating a significant response from the US healthcare system. Important responses to this sweeping legislation include an update of strategic and capital planning, optimization of revenue cycle management, labor and the supply chain, and development of new sources of nonoperating revenue to support the organization’s mission. The OBBBA represents a movement toward a market-based healthcare system in which healthcare organizations must become less dependent on third-party reimbursement and more reliant on disposable spending, nonoperating revenue, and market-based demand.
Private capital has been a powerful force in driving healthcare innovation, fueling digital tools, team-based care models, and many other modernizations of care. Yet skepticism remains about whether financial investment can align with improved outcomes, improved access, and lowering of costs based on negative examples. In a healthcare system that spent $4.9 trillion in 2023, with most of the supporting investment funded by nongovernmental sources, the role of private capital is not just influential but essential. Consequently, working to reduce negative implementations and increase transparency is worthwhile based on the needs for innovation in healthcare—digital and physical. This article provides approaches for private investment to analyze not only financial return on investment but also health value return on investment (HV-ROI). That means measuring how well capital deployment improves care outcomes, expands access, targets community needs, and supports providers while impacting healthcare costs. Investors should be true health partners. Adopting HV-ROI practices can help them and partnering healthcare executives align financial goals with value—driving both financial viability and improved outcomes for patients and communities. Key insights include: Blended funding is essential. Public programs, philanthropy, and private investment each play a role. Only together can they support the cost of care, scale proven solutions, and sustain innovation across all communities. Private investment must evolve. While it has enabled telehealth, diagnostics, and behavioral health platforms, instances of private for-profit investment with poorly aligned incentives have also led to staffing cuts, reduced services, and worse outcomes in areas like emergency medicine and nursing homes. HV-ROI offers a solution. This framework proposes embedding health value throughout the investment lifecycle: Evaluating clinical outcomes, access, affordability, and local needs Aligning investment key performance indicators with patient, provider, and payer priorities Building governance structures that reward long-term health impact Transparency and accountability matter. Publishing impact analyses, engaging third-party evaluators, and sharing lessons learned will build trust and legitimacy.
The urgent need for healthcare transformation in the United States has long been evident. The traditional system of healthcare in a community has typically revolved around the acute care center, whether these communities are in large city neighborhoods or in remote rural areas, hundreds of miles from tertiary or quaternary services. One way in which healthcare leaders can transform systems of care is by considering local acute care centers as one aspect of a larger care ecosystem. Healthcare’s most expensive work is in the acute care center. By most estimations, 25 percent of that work is waste (Bauchner and Fontanarosa 2019). According to the most recent data by the Centers for Medicare & Medicaid Services (CMS), national health expenses grew 7.5 percent in the year ending 2023, with hospital expenses experiencing double-digit increases (Centers for Medicare & Medicaid Services 2025). Building systems of care with the highest quality of service in the most coordinated and cost-efficient manner is needed more than ever. Despite limited resources, we must begin to invest capital dollars in value-based care and promote it in capital investment conversations as the leading strategy for healthcare systems.
Health system venture groups are far more than finance vehicles on the periphery of care delivery. They serve as high-impact engines for clinical and operational innovation, empowering frontline clinicians, administrators, and care teams to reimagine and improve how care is delivered and experienced. By providing dedicated funding, strategic focus, and governance, these groups accelerate the adoption of breakthrough technologies, expand access to specialized services, and optimize clinical workflows. Their unique access to healthcare environments allows them to validate, implement, and spread impactful innovations faster than traditional investors. The result is better outcomes for patients, reduced burnout for providers, and sustainable growth for the health system. This article explores why ad hoc innovation stalls without governance, how venture capital functions as a capability enabler, and the purposeful design of Intermountain Ventures as a model for other health systems. We also examine concrete examples of successful investments—in areas such as care delivery, access to care, and next-generation technology—and offer a practical playbook for executives looking to launch or refine their own venture programs. Finally, we reflect on the strategic imperative of putting mission-based capital to work, today and in the future, enabling responsible innovation with long-term impact.
Kaiser Permanente occupies a unique space in today’s healthcare marketplace. It is the largest managed healthcare organization in the United States, providing care to 12.6 million members in eight local markets at 40 hospitals and more than 600 medical offices. With a fully integrated, patient-focused system of care, Kaiser Permanente is realizing improved health outcomes and satisfaction for its patients, while ensuring physician wellbeing and engagement of the entire care team. The integrated, team-based system is supported by an industry-leading electronic medical record system, an embrace of emerging technologies as care support tools, and a commitment to drive optimal, short- and long-term patient outcomes. This article highlights the value of integration and systemness, provides examples of Kaiser Permanente’s unique approach, and outlines the vital roles that technology and team-based care play in ensuring Kaiser Permanente’s innovative and integrated approach, as it achieves improved health outcomes.
Over the past decade, OSF HealthCare has undergone a bold and deliberate transformation to evolve from a collection of hospitals and ambulatory sites into a unified, high-performing health system. In an era marked by rapid industry change, escalating costs, staff shortages, and technology transformation, along with the need for consistent, high-quality care models across diverse sites, OSF recognized that its operating model would not be sustainable for its future in healthcare. Without a consistent operating model, members of the same organization would operate in leadership silos, have inconsistent strategies, and struggle to achieve operating efficiency, all of which could create internal competition. With a renewed vision of One OSF, the organization embarked on a journey to systemness by prioritizing integration, cultural alignment, and innovation. Leadership restructured core functions, such as analytics, human resources, IT, legal, marketing, and communications, while establishing centralized roles and enterprise-wide analytics to drive performance. Through the creation of the Integration Management Office, OSF brought structure and consistency to growth efforts, ensuring that new acquisitions shared the same values and standards without losing their local relevance. Systemness proved especially vital during the COVID-19 pandemic, enabling OSF to dynamically reallocate resources and staff across its care sites. Today, with a focus on delivery system redesign, virtual care models, and artificial intelligence (AI)-driven tools, OSF is building a sustainable, scalable healthcare model tailored to the unique needs of the communities it serves, including those in rural settings. This article explores the OSF HealthCare journey to systemness, examining how a clear vision, aligned leadership, and strategic innovation enabled a seamless care experience, while driving efficiency, resilience, and long-term viability across a growing network.
