The hardest work ahead for CFOs isn’t finding opportunities for growth. It’s narrowing them.
In a recent conversation with “Becker’s Healthcare Podcast,” Sophia Holder, executive vice president and CFO of Children’s Hospital of Philadelphia, described the next phase of leadership as one defined by discipline and discomfort.
“Our hardest work ahead is continuing to make disciplined and really sometimes uncomfortable decisions while staying grounded and anchored in our mission,” she said. “That includes likely saying no to investments that do not clearly advance access, quality and sustainability, and pushing ourselves to rethink legacy structures and our ways of working.”
Many finance leaders are confronting a similar balance between team performance in the near-term and long-term capability building. Headwinds including labor shortages, increasing costs and reimbursement pressure are making a huge impact on hospitals’ bottom lines, while the dearth of technology and AI-driven platforms can easily become expensive solutions in search of a problem.
“We are in an increasingly complex healthcare landscape. How do we grow and innovate in a sustainable way?” Ms. Holder said. “For us, this means having more honest conversations, making really clear choices, really tuning into our prioritization framework and aligning our resources with what matters most for children and families. The result was not only to improve financial performance, which I was really grateful for as CFO, but create stronger organizational alignment and a clear connection between the financial decisions and patient impact.”
Hospital C-suite executives are accountable for balancing near term performance with long-term capacity building. Given the uncertainties in healthcare today, many are taking a more conservative approach and forgoing investments they may have made in the past, even if those investments have marginal returns.
“We are focused on sustaining financial performance in an environment of continued labor pressures, reimbursement dynamics and ongoing volatility in volumes,” she said. “At the same time, we are prioritizing long term capability building.”
That includes workforce optimization, revenue cycle resilience and capital discipline. It also means the leadership team is zeroing on responsible deployment of automation and AI to reduce administrative burden and improve data-driven decision-making.
“The challenge is balancing near term performance with these longer term investments so that we do not compromise access, do not compromise growth in our longer strategic objectives, or we do not compromise innovation for children and families,” she said.
CHOP’s leadership team has a strong growth mindset and sees the best opportunities at the intersection of mission and discipline, Ms. Holder said. In the coming year, the organization plans to expand access through ambulatory and virtual models, strengthen partnerships regionally, nationally and internationally, and add services that will differentiate outcomes for patients.
Internally, growth means adding capabilities and developing leaders.
“We are focused on modernizing our operating models, and as the CFO, we are also focused on embedding this notion of financial stewardship into everyday decision making,” said Ms. Holder. “It’s not a one-off; it’s ingrained in our culture. When we do that well, growth becomes sustainable, not just bigger. We’re not just bigger, but stronger. This is an exciting time for us at CHOP, ripe with opportunities despite the changes that are surrounding the entire healthcare landscape.”
