Hospital and health system CFOs have long been stereotyped as the leader that says “no” to everything – more commonly dubbed the “CF-No.” However, finance leaders at the Becker’s 14th Annual CEO+CFO Roundtable said that is a dated reputation, with their job to help the CEO find a way to say “yes.”
“When I look at the relationship with [HHM Health’s president and CEO Brian Hawkins], my job is to help him succeed…going beyond the CF-No mentality,” David Hernandez, CFO of Dallas-based HHM Health, said during the panel titled “Power Growth Through Dynamic CEO-CFO Relationships.”
Mr. Hernandez said there was a joke in his office where colleagues brought him a “no” button, and have kept track of when he uses it. Luckily, he said, he hasn’t used it in awhile.
From the CFO seat, Mr. Hernandez said it’s not just about saying no to projects or discarding new opportunities, but it’s about understanding what the CEO wants to do to achieve a strategy that’s already put in place.
“Ensuring that I can gather enough information to help him understand where the priorities need to be in terms of new projects or new opportunities [is key],” he said.
Ernest Ngirimana, CFO of Atlanta-based Emory Healthcare’s physician division, said his team has evolved past the “CF-No” idea.
“We’ve actually evolved it a little bit to ‘CF-How,'” he said. “Rather than starting with no and reasons why things can’t be done, how can you be the facilitator of the best yes?”
Mr. Ngirimana said Emory has grown from a $5 billion organization to a $9 billion one in three years, a kind of growth that comes from investing in multiple different pathways as a team.
He said the best kind of sequencing usually comes from the first investment funding the next. For example, Mr. Ngirimana said there is a large demand for the system’s services in Emory’s Atlanta market.
“The easy thing to do is always to open another clinic or to open another facility…,” he said. “Recently, we’ve had to pivot a little bit and think a little bit more in terms of what fixed assets do we have that we are not actually maximizing, and how do we make sure that the expanded access actually happens in the fixed costs we already have, rather than going and adding some more. Those kinds of conversations are ongoing.”
For Britt Tabor, executive vice president and CFO of Jacksonville, Fla.-based Brooks Rehabilitation, the answer can be “not yet” rather than “no.”
Brooks Rehabilitation has a five year plan that is updated every six months. Mr. Tabor said from an operational standpoint, seeing the organization’s projects then starting on a timeline can boost energy for employees.
“[The projects] might not be next fiscal year, but 2028,” he said. “This is a priority, and it’s worked. It really gives people excitement and buy-in.”
Brooks Rehabilitation is in a period of growth, investing in a $68 million expansion plan that includes three projects in 2026. Mr. Tabor said they weigh each decision against three questions:
- Does it fit the mission?
- Is it sustainable?
- Can the team execute it?
“If all of those are saying, ‘yes, yes, yes,’ then we move forward,” he said.
The panelists agreed that the shift in the CFO role relies on building trust before making tough calls.
Mr. Hernandez said he now brings projects to Mr. Hawkins himself, with ROI already worked out. Mr. Ngirimana also said the CEO-CFO relationship should work to build trust “when times are good” so it can be leaned on later should times get hard.
“The success of the CEO is the success of the CFO,” Mr. Hernandez said. “The sooner we realize that … the better results we’re going to get.”
