The role of the health system CFO has evolved far beyond traditional number crunching, managing budgets, overseeing audits and reporting quarterly results. Today’s top CFOs are increasingly expected to challenge assumptions, influence enterprise strategy and, at times, tell CEOs what they don’t want to hear.
That was one of the major themes to emerge from a June 3 report from executive search firm WittKieffer, which interviewed CFOs from leading health systems, including Rochester, Minn.-based Mayo Clinic, Grand Rapids and Southfield, Mich.-based Corewell Health, St. Louis-based BJC Health and Dallas-based Texas Children’s, among others.
“A great CFO protects the CEO from themselves,” Mike Blair, senior vice president and CFO of St. Cloud, Minn.-based CentraCare, said in the report. “You need the courage to walk into the office and say, ‘I don’t think this is a good idea, and here’s why.’ That kind of truth-telling only works when you challenge respectfully, from a place of wanting the organization to succeed.”
Robert Chestnut, senior vice president and CFO of Lawrence, Kan.-based LMH Health, recently spoke with Becker’s about the evolving CEO-CFO relationship and the importance of both leaders being aligned on the system’s strategic vision and the path to achieving it.
“There’s always a thousand things to do. How do I focus? How do I work collaboratively with the management team to say, ‘Let’s figure out what are the most important three or four things.’ One thing I try to do is put numbers to that,” Mr. Chestnut said. “What are the biggest bangs for the buck and initiatives that we can undertake in any given year? There are always more initiatives than there is time to do it. Let’s figure out the things we can get some early wins on, and things that we think will transform the organization, versus trying to push 20 things at a time.”
According to the WittKieffer report, the best CFOs are not defined by technical expertise alone.
Their influence increasingly stems from their ability to challenge consensus, build trust and shape decisions across health systems where authority is often distributed among clinical, operational and administrative leaders.
“I think the role, rather than being the lead as a strategist, is a connector. How do you pull together clinicians, departmental managers and stakeholders, and move them in a direction for the organization,” Perry Sham. CFO of Niagara Falls (N.Y.) Memorial Medical Center, told Becker’s. “Sometimes you will bring up a new service or work through a new initiative, and a big part of the job isn’t necessarily to make the decisions of that, but it’s to pull the right folks together and provide them with the information needed to drive that initiative.”
As health systems grow larger and more complex, CFOs are being pulled into conversations that extend far beyond finance. They are helping evaluate mergers and acquisitions, oversee technology investments, assess value-based care strategies and guide long-term capital allocation decisions. Financial leaders are now involved earlier in strategic discussions, helping organizations test assumptions and evaluate trade-offs before decisions are made.
“The CFO role has fundamentally shifted from being called in after the deal is baked to asking, ‘does this make sense?’ from the beginning,” Scott Hawig, executive vice president and CFO of St. Louis-based BJC Health, said in the report. “I find myself leading from the front rather than from the back.”
That expanded role requires a different leadership approach. Rather than relying on authority, many CFOs said their effectiveness depends on influence, communication and credibility.
“One of my biggest areas of growth has been learning to use influence,” Matthew Cox, executive vice president and CFO of Corewell Health, said. “Making decisions within your own domain is table stakes for a CFO. The real leadership challenge is shaping outcomes beyond your direct scope — across the organization and into the broader industry.”
The report also found that communication is one of the most difficult skills for finance leaders to develop. CFOs are increasingly expected to translate complex financial realities into narratives that resonate with boards, physicians and operational leaders.
“Taking a complex topic, simplifying it, and making it clear — that’s the hardest skill to develop,” Weldon Gage, executive vice president and CFO of Texas Children’s, said in the report.
Ultimately, the modern CFO’s value comes from serving as a trusted advisor capable of balancing financial discipline with strategic judgment versus only being a gatekeeper, according to the report. That includes having the confidence to challenge the CEO and other C-suite leaders when necessary.
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