In 2024, Suroit Hospital, a semirural hospital in Quebec, Canada, faced the imminent loss of 20 acute care beds following a provincial directive limiting the use of private agency nurses. This immediate workforce shortage threatened essential inpatient services for a geographically isolated population, while surrounding urban hospitals lacked the capacity to absorb diverted patients. To prevent closures, the hospital partnered with the Santé Québec West Central Montreal Health and Social Services University Network (SQ-WCMTL) and its Jewish General Hospital University Centre to rapidly deploy a virtual inpatient unit - to the authors' knowledge, the first of its kind in Canada. This Case Study outlines the challenge, design, execution, and outcomes of a two-phase intervention: a 10-day rapid design and mobilization phase culminating in the admission of the first patient, followed by a 5-month hub-and-spoke operating phase. The model enabled Suroit Hospital (part of the Santé Québec-Montérégie West [SQ-MW]) to maintain inpatient capacity without on-site registered nurses. Physicians, licensed practical nurses, and patient care attendants delivered hands-on care locally, while experienced registered nurses - JGHUC employees - provided continuous virtual assessments, medication oversight, and real-time escalation support. Over the first 5 months, the virtual unit generated 786 hospitalization days that would otherwise have been lost. Fourteen patients were admitted in the first 2 weeks, with no transfers to urban hospitals and no adverse safety events. The average length of stay was 9.6 days. Among survey respondents, staff-reported effectiveness in their role was 47% in August 2024 (8 of 17 respondents) and 87.5% in October 2024 (7 of 8 respondents). Comfort with the virtual care technology was reported by 76.5% (13 of 17) in August 2024 and 100% (8 of 8) in October 2024. Patients reported satisfaction, valuing the ability to remain close to home. The rapid implementation surfaced several hurdles, including initial skepticism about safety without on-site registered nurses and communication delays during the first days of operation. Strong executive sponsorship, twice-daily huddles, structured escalation pathways, and agile project management enabled rapid problem-solving and continuous refinement. The initiative demonstrated that virtual nursing models can maintain - and even strengthen - quality and safety when supported by digital readiness, clear governance, and strong interinstitutional trust. After the 5-month operating phase, SQ-MW launched its own virtual ward team, allowing JGHUC to exit the operational model. Although that transition and sustainability phase was not evaluated as a formal study phase, it suggests that the intervention served as a capacity-building pathway toward spoke-site autonomy. This hub-and-spoke approach offers a replicable framework for health systems facing workforce shortages, semirural service disruptions, or inpatient capacity constraints. Likewise, virtual inpatient units can preserve equitable access to care and sustain essential services in communities where conventional staffing models are no longer viable.
Artificial intelligence (AI) offers the potential to improve productivity and reduce waste across the U.S. health care system. Quantifying achievable value from AI technologies can inform organizational strategies and national spending projections. This study aimed to estimate the annual run-rate net value achievable within 5 years through full adoption of AI use cases across major health care stakeholders and domains without compromising quality or access. This study applied observed implementation benchmarks and national expenditure data to 12 AI-enabled domains spanning five stakeholder groups - private payers, public payers, hospitals, physician groups, and other sites of care - collected during the period of October 2023 and March 2024. The financial impact was estimated using 2024 data (the latest year for which full data are available) of U.S. health care expenditures, using ranges from published literature and observed implementation evidence. No human participants were involved. The analysis considered the savings potential from full national implementation of three specific AI technologies - machine learning (ML), natural language processing (NLP), and generative AI (genAI) - across administrative and medical expense categories for payers and providers (but excluded onetime implementation costs). Annual net value (2024 U.S. dollars) and percentage reductions in total, administrative, and medical expenses by stakeholder group and AI technology were assessed. Assuming full adoption - i.e., a health care environment in which all stakeholders are all-in on AI adoption for all domains across administrative and medical expenses for all designated AI technologies, in this case, ML, NLP, and genAI - AI could generate US$438.9-US$810.7 billion in annual net value (5.7%-10.6% of the US$7.7 trillion in 2024 total health care expenses). GenAI-led use cases account for 54.4%-55.9% of the total AI opportunity. Administrative expenses could decline by US$120.1-US$252.0 billion (9.4%-19.8%) and medical expenses by US$318.8-US$558.6 billion (5.0%-8.7%). By stakeholder group, estimated annual values are as follows: private payers, US$205.1-US$357.0 billion (7.0%-12.1%); hospitals, US$130.6-US$219.5 billion (8.6%-14.4%); physician groups, US$29.0-US$89.9 billion (2.8%-8.6%); public payers, US$62.4-US$107.4 billion (5.1%-8.8%); and other sites of care, US$11.9-US$36.9 billion (1.3%-4.0%). Financial impact is concentrated in health care management, provider relationship management, and claims management for payers and in clinical operations and quality and safety for providers. Labor productivity and administrative automation account for the largest share of impact. Full implementation of these AI technologies could reduce U.S. health care spending by up to US$810.7 billion within 5 years without compromising quality and access. Realizing this full potential would require properly aligned incentive models (e.g., between physicians and the hospital), as well as coordinated organizational change, workflow redesign, and infrastructure investment, especially in clinical domains. Responsible scaled adoption supported by policy and industry efforts could help bend the U.S. health care cost curve.
NEJM Catalyst Insights Council members say their organizations are rapidly adopting a wide range of data innovations that promise to remake health care delivery - eventually.
A 2023 workforce engagement survey of employees at the Houston Methodist Physician Organization (HMPO) identified a widening engagement gap between physician and nonphysician staff members. A greater number of physicians reported disengagement, mirroring a national trend in declining engagement scores, than other employees. Recognizing that low levels of physician engagement can negatively impact physician retention, patient care, and organizational success, in 2024, HMPO launched a focused Joy in Medicine Initiative (JIMI) aimed at bridging the engagement gap. The JIMI workplan, led by the Office of Professional Fulfillment and Experience (ProFEx), incorporated several components, including a listening and learning (L&L) tour facilitated by the Chief Executive Officer, and applied qualitative and quantitative methods to gather insights directly from physicians and other nonphysician clinicians in the primary care group. This intentional approach to planning and executing the L&L sessions yielded an overall participation rate of 76% among 232 eligible patient care clinicians. Feedback revealed key drivers of engagement and joy, including timely schedules, organizational pride, strong team relationships, and institutional electronic health record support. A second method to gather feedback involved the use of a crowdsourcing approach that yielded 66 unique improvement ideas. A thematic analysis of the feedback gathered from both approaches provided a holistic picture of the factors driving physician disengagement, including administrative burden, in-network referral difficulties, and a lack of mental health support for patients. To assess fulfillment and burnout, ProFEx deployed a well-being survey for clinicians, which revealed high professional fulfillment for physicians, with burnout rates below, but near, benchmarks representing concerning levels for national academic health centers as established by the Healthcare Professional Well-being Academic Consortium (PWAC). ProFEx's findings underscored the need for a multifaceted approach to improve engagement while addressing burnout. ProFEx and HMPO leadership developed a strategy informed solely by input from physicians and nonphysician clinicians using the Stanford Professional Fulfillment Index, which considers three domains: culture of wellness, efficiency of practice, and personal resilience. In the first year of the strategy's execution, HMPO accelerated the deployment of ambient listening technology to reduce documentation burden and fostered personal and community resilience through the Houston Methodist (HM) network-wide JIMI events, such as commensality dinners. HMPO also launched a philanthropic mini grant program, daily team check-ins with leadership escalation (i.e., daily management system and tiered huddles) to enhance communication, and a peer support program to further strengthen the culture of well-being for HMPO clinicians. In 2025, HM secured bronze-level recognition in the American Medical Association's Joy in Medicine Health System Recognition Program. In the fall of 2025, ProFEx administered a second workforce engagement survey. Amongst primary care physicians who experienced a year of the JIMI strategy, survey results indicated improvements in engagement, alignment, safety culture, and safety. The JIMI offers actionable insights for other health care organizations.
Communication and teamwork are essential for providing safe and effective health care, particularly in light of increasingly complex health care teams comprising multiple disciplines. In late 2021, the Heart Failure Center of Excellence (HF Center) at Tampa General Hospital sought assistance from senior leadership to improve communication and teamwork in their center. In response, senior leaders established an intervention team with a goal to design and implement a customized solution to improve the culture of the HF Center. The intervention team consisted of the Chief Executive Officer, who has a Doctor of Business Administration (D.B.A.) degree, two Ph.D.-level industrial-organizational psychologists who were part of an existing internal culture and leadership research team, and an internal M.A.-level organizational development senior director. The execution proceeded in three stages. First, the nature of the problem was assessed by surveying all HF Center members from frontline staff to senior management. Second, a communication and teamwork intervention was designed and delivered. Finally, the impact of the intervention was evaluated by comparing surveys from before and after the intervention. A baseline survey supported a qualitative approach to identify the HF Center's issues as seen by its members, including physicians, other care staff, and leadership. The first question was multiple-choice, to determine their role in the team. That was followed by six open-ended questions asking respondents to provide one to three adjectives that best describe their team; to note the best thing about the team; to describe the team culture, team communication, and team trust (one question for each); and to offer suggestions for improvement. A content analysis by the intervention team identified communication as a major issue in the HF Center. The intervention solution was an application of the Survey Feedback method in which the results of the survey were fed back during a half-day retreat, and the HF Center members used those results to craft their own plan to improve the identified issues. The same questions were repeated in a November 2022 survey, with sentiment analysis showing a marked improvement in terms of more positive and fewer negative comments. In addition, a comparison of results from the annual Press Ganey engagement survey showed improvements in teamwork from May-June 2021 (before the intervention) to June 2023 (after the intervention). The results of the two annual surveys and the two intervention surveys suggest the effectiveness of a customized Survey Feedback approach that included team-building exercises that enabled the HF Center team to discuss results and come up with their own solutions. Allowing all team members from frontline to senior management the opportunity to participate supports engagement and acceptance, which can contribute to the success of the intervention.
Waiting times for specialist visits in the United States are increasing, and many organizations are responding by seeking to hire more physicians. However, regional data on the supply of physicians in various specialties and waiting times suggest that this approach alone is unlikely to be effective and may even worsen the problem. This observation is consistent with the dynamics observed when lanes are added to highways but fail to reduce congestion because drivers' thresholds for using the highways are lowered. Meeting this challenge will most likely require other tactics (analogous to those used to solve traffic congestion) that change the way specialists use their time, incorporate advanced practice providers, and take advantage of advances in information technology.
The adoption of technologies rooted in AI is increasingly hailed as a path to greater efficiency in health care. One assumption often underpinning this view is that staff time saved by AI tools can and will be converted into increased productivity or cash savings. This commentary argues that health care organizations need to have explicit, feasible, and adequately resourced plans for converting any saved staff time into improved outcomes for managers, patients, and staff. It also highlights the important role that logic models can play in that planning. By shifting the focus from what AI tools can accomplish to what health care systems can achieve by using them, logic models have the potential to help health care organizations navigate the hype and secure the genuine benefits that AI can bring.
Patient grievances are an inevitable part of health care delivery, yet existing review processes do not focus on the unforeseen harms that grievances can have on the health care team. At a large academic children's hospital, a human-centered approach was used to redesign the grievance review process. Through listening sessions with frontline physicians and the formation of a multidisciplinary work group, the authors developed and implemented a novel approach to responding to patient concerns related to physician care, while also supporting the physicians. The redesigned process focused on communication and process, which over time evolved to approaches that were human-centered and systems-focused. Postimplementation physician feedback demonstrated an improved experience with the revised grievance review process, a marked improvement in their understanding of the process, and a reduction in feelings of being unsupported. The feedback also highlighted the importance of sharing available wellness resources with the hospital's physicians. This human-centered redesign preserved accountability to patients while creating a more just culture for physicians. The authors' experience suggests that patient grievance processes can and should still serve as opportunities for learning, rather than occasions for blame that could sow harm; the authors offer a replicable framework for institutions seeking to support both patients and the physicians who care for them.
Clinical trials remain the foundation of evidence-based medicine but often fail to reflect the diversity, complexity, and real-world contexts of the populations they are intended to serve. Insights from the 2025 Symposium to Strengthen Health Research highlight structural barriers - including restrictive eligibility criteria, historical mistrust, inequitable access to trial sites, and misaligned research incentives - that limit equitable participation. Addressing these challenges requires a shift toward community-engaged research, pragmatic and decentralized trial designs, and artificial intelligence-enabled tools that connect patients with appropriate studies. This article outlines a cross-sector strategy for embedding equity, real-world relevance, and patient partnership into the design, funding, and implementation of clinical research.
This article advances a set of actionable recommendations informed by the Prevention and Treatment of Chronic Disease in the Southeast Symposium hosted April 30, 2025, at Emory University. Key strategies include expanding team-based care that integrates community health workers, behavioral health specialists, and social services into primary care; realigning financial incentives to reward prevention; and making evidence-based lifestyle and behavioral interventions standard components of care. Prevention must also be grounded in community-rooted strategies that rebuild trust, improve access in underserved areas, and address social determinants of health. Technology, including data analytics, remote monitoring, and artificial intelligence-enabled decision support, should be deployed to strengthen risk stratification, outreach, and care coordination, with equity and accountability as nonnegotiable requirements. Together, these recommendations define a practical, scalable road map for transforming prevention from a peripheral activity into a central organizing principle of the health system. Policy makers, payers, health systems, employers, and funders must act within defined time horizons to align incentives, scale proven models, and institutionalize prevention as a core function of care delivery in the Southeast United States.
Extreme heat is a deadly but underreported health crisis that disproportionately affects vulnerable populations. This article, informed by the 2025 regional symposium Fostering Collaborations: A Symposium to Advance Equitable Heat Health Actions, identifies systemic barriers to heat resilience, including data fragmentation, siloed infrastructure planning, and a lack of rigorous evaluation for common interventions. Addressing these challenges requires a shift toward longitudinal cross-sector collaborations. Key recommendations include integrating heat-risk screening into clinical workflows, embedding thermal comfort into zoning and capital planning, and establishing formal governance roles like heat officers. By prioritizing community-driven solutions and climate justice, Massachusetts can establish a scalable national model for equitable heat health action.
Digital health technologies offer powerful tools to prevent and manage chronic disease, yet fragmentation, unfair access, and slow implementation limit their impact. Informed by the 2025 inaugural Arizona Digital Health Symposium, this article presents a strategic road map spanning three domains: expanding digital prevention tools, enhancing technology-enabled care delivery, and optimizing health data integration. The authors emphasize foundational priorities including privacy, interoperability, culturally grounded design, Tribal engagement, and cross-sector governance. A phased implementation plan outlines short-, intermediate-, and long-term actions to accelerate the translation of innovation into impact. Sustained collaboration across the academic, public health, clinical care, technology, and community sectors is essential to achieve fair, scalable improvement in population health.
Transforming the U.S. health system requires coordinated alignment across financing, care delivery, workforce, and innovation infrastructure. Persistent fragmentation, fee-for-service incentives, administrative burden, and underinvestment in primary care continue to undermine outcomes and drive unsustainable costs, particularly for communities with limited access to preventive and social supports. This article synthesizes policy and operational strategies to advance value-based care, integrate social determinants into risk adjustment, modernize data systems, strengthen safety-net capacity, and build workforce resilience. A sequenced road map outlines short-, intermediate-, and long-term actions, led by federal and state agencies, private sector partners, and community organizations, to achieve durable improvements in quality, equity, and cost.
Rural communities face widening mortality gaps driven less by geography than by policy choices shaping care delivery, workforce distribution, and investment. Informed by the 2025 Dartmouth Rural Health Symposium, this article synthesizes evidence and field experience to outline a practical reform agenda. The authors propose redefining rural hospitals around essential, financially viable services; scaling team-based and artificial intelligence-supported care; modernizing payment models; and rebuilding trust through community partnership. A phased implementation plan proposes near- and long-term actions and highlights responsibilities across sectors. Durable progress will depend on aligning incentives with prevention and local relevance, allowing proven innovations to move from isolated pilots to routine practice nationwide.
This article synthesizes findings from the Reengineering Health Decision-Making Environments: Aligning Research, Policy, and Innovation for Societal Benefit symposium. Health decisions by patients and providers are often suboptimal, not because effective knowledge or tools are unavailable, but because the conditions under which decisions are made do not support their best use. The symposium brought together researchers, practitioners, and policy makers to examine how health decision-making environments could be reengineered to improve decisions across the care continuum. Three complementary levers emerged as especially promising: behavioral science principles, learning health systems, and artificial intelligence. Achieving these gains at scale will require sustained investment in embedded testing infrastructure, payment and regulatory models that support delivery innovation, and equity-centered design from the outset.
The symposium Breaking the Boundaries: Reimagining Research and Clinical Practice for a Healthier Tomorrow, held June 9-10, 2025 in New Orleans, Louisiana, convened leaders across research, health systems, community organizations, policy, and philanthropy to explore strategies for addressing these challenges. Discussions focused on elevating community priorities, decentralizing care, realigning incentives, and accelerating the translation of evidence into practice. The perspectives and recommendations presented here draw from the insights generated at this event, emphasizing the need for intentional redesign of current research, funding, and implementation systems. By centering community-defined outcomes, integrating multisector partnerships, and embedding implementation science from the outset, these approaches aim to close the persistent evidence-to-practice gap and create sustainable, scalable models of care that improve health equity in the Deep South.
Maternal health outcomes in the United States remain constrained by fragmented care, inequities, and gaps in postpartum support. Payers, particularly Medicaid, are uniquely positioned to address these challenges through payment reforms, data-driven interventions, and cross-sector partnerships. Informed by the Symposium to Strengthen Maternal Health Research: Payer Strategies to Improve Maternal Health Care, this article presents a strategic framework for payer-led action, emphasizing early pregnancy identification, coordinated care, culturally tailored services, and equity-focused quality measurement. Short-, intermediate-, and long-term priorities outline pathways for research, implementation, and scaling of effective strategies. Sustained collaboration among payers, providers, researchers, policy makers, and communities is essential to improve maternal health outcomes.
