Hospital and health system CFO roles have evolved from shaping board discussions to aligning operational and clinical leaders to organizational realities, translating complex financial language that helps move the ship forward. However, existing CFOs say the key driver that separates effective finance leaders from others is finding clarity under pressure.
“The true measure of a good CFO lies not just in the outcomes, but in the story they tell,” Matt Huff, executive vice president and CFO of Danville, Pa.-based Geisinger Health, said in WittKieffer’s “The Healthcare CFO: Leading Financial and Strategic Transformation at Scale” report. “It’s about crafting a narrative that allows you to steer the presentation and messaging. In a room filled with board members and diverse stakeholders, the ability to keep the conversation on track is a rare skill, difficult to teach but essential to master.”
The WittKieffer report is based on in-depth discussions with sitting CFOs across health systems that range from critical access hospitals to large academic medical centers. The firm found that communication is a key strategy that can be difficult to develop, even over strategic thinking, capital allocation and comfort with ambiguity.
Weldon Gage, executive vice president and CFO of Houston-based Texas Children’s said in the report that external pressure facing hospitals make it paramount for CFOs to clearly communicate these challenges with executive colleagues, boards and physicians.
“Taking a complex topic, simplifying it, and making it clear — that’s the hardest skill to develop,” Mr. Gage said.
The findings run in tandem with how finance leaders are often trained. In the study, 55% of CFOs started their careers in accounting firms, with 59% holding CPA certification and only 46% with an MBA.
While these credentials build technical credibility, the report said they no longer distinguish leaders once they’ve reached the enterprise level.
“You can stay in a traditional finance role and arbitrate according to the rules, or you can help people understand the ‘why’ and create systems that allow the organization to be agile,” Robin Damschroder, executive vice president, president of value-based enterprise and CFO at Detroit-based Henry Ford Health, said in the report. “If you create agility, the organization can run faster.”
The report also said that formal training rarely helps deliver strong communication skills. Board presentations, clinical leadership meetings and difficult budget discussions helped develop the ability to read a room and respond accordingly.
Matthew Streeter, CFO of Whitefield, N.H.-based North Country Healthcare, said what helped prepare him for his existing role was life experiences, not just previous roles.
“I draw more on my background in education, psychology, banking and human resources than on financial acumen, and those skills are tested every day,” Mr. Streeter said.
Scott Hawig, executive vice president and CFO at BJC Health in St. Louis said the communication expectation has shifted along with the scope of the role itself.
“The CFO role has fundamentally shifted from being called in after the deal is baked to asking, ‘Does this make sense?’ from the beginning,” Mr. Hawig said. “I find myself leading from the front rather than from the back.”
The report said CFOs now often devote around 50% to 60% of their time to strategic finance, an increase from a decade ago when operational finance was the main driver. CFOs are now expected to provide insights on population health strategy, capital prioritization and alternative care models.
These expanded requirements can make communication not an ancillary skill but an important leadership capability.
“To be effective, system CFOs have to be highly strategic and comfortable integrating finance with other functions,” Andrew Zukowski, CFO of Greenville, N.C.-based ECU Health, said. “The role is becoming much more outward-facing — forging market relationships, helping the board navigate change. Leadership, not technical finance expertise, will continue to define success.”
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