As hospitals face financial pressures, workforce shortages and policy shifts, CEOs are walking a fine line: protecting stability while taking steps to keep their systems competitive.
Becker’s connected with eight health system leaders to learn how they decide which risks to take — and which guardrails to hold.
Where leaders are holding firm
Newark, Del.-based ChristianaCare is holding firm on its growth strategy. It is “focused on creating sustainable growth such as bringing care closer to home and whenever possible, into the home, because we believe that’s the future of care,” Janice Nevin, MD, president and CEO of ChristianaCare, told Becker’s.
At the same time, that strategy involves risk.
“Programs like hospital at home carry regulatory, legislative and insurer-related uncertainties,” Dr. Nevin said. “Despite this, we will continue to make significant investments in these innovative programs because we are committed to redefining how and where patients receive quality care.”
As a physician-led organization, Fort Wayne, Ind.-based Parkview Health is committed to high-quality care and patient safety, CEO Rick Henvey told Becker’s. It is also focused on expansion.
“As more rural hospitals are closing across the country, we have recently announced the addition of several new hospitals and clinics throughout Northern Indiana,” Mr. Henvey said. “As we enter the fourth quarter, we will continue to expand services and technology — especially when it means we can increase access to care or advance the quality of care in those rural communities across Indiana and Ohio.”
When thinking about navigating the rest of 2025 and preparing for 2026, James Leonard, MD, president and CEO of Urbana, Ill.-based Carle Health, is focused on controllables. One key is workforce development: hiring, education programs and maintaining a strong culture of being resilient and nimble, Dr. Leonard told Becker’s. It is also moving forward with its program to offer nursing students full tuition coverage and a guaranteed role in the health system.
“We think it is going to be real important to maintain those traits and characteristics in our workforce as a lot of the details around reimbursements and clinical challenges become more evident to all of us,” he said.
New Orleans-based LCMC Health is also holding firm on workforce stability, as well as protecting financial discipline.
“The past few years have amplified what we already knew: Our people are our greatest asset,” CEO Greg Feirn told Becker’s. “That means being disciplined about core operations, maintaining service lines that our communities depend on, ensuring staffing models are sustainable, and keeping patient safety and quality at the center of every decision.”
Mike Thomas, president and CEO of Walnut Creek, Calif.-based John Muir Health, told Becker’s the system is focused on investing in employee engagement and physician alignment. He also said more proactive and diligent payer relationship management is important as the system is experiencing more payment delays and denials in 2025. Additionally, John Muir Health is holding firm on any decision that drives up its expense base, with a focus on carefully managing its balance sheet.
“We need to continue to invest in accretive growth opportunities, both from a clinical program perspective and a geographic market perspective,” Mr. Thomas said. “We know that we can’t shrink our way to success. We are diversifying revenue sources by growing our ambulatory care footprint in our service area and continuing to invest in the growth of critical programs, including cancer care, cardiovascular care, neurosciences, and women’s and children’s services.”
Robert Stone, CEO of National Cancer Research Institution City of Hope, has identified key points of investment for patients. This includes creating access to world-class cancer care and innovation by investing in a centralized, national clinical trials model, which allows the system to leverage expertise in different regions without replicating resources, he told Becker’s. Mr. Stone is also focused on reframing the definition of value for patient-centered cancer care.
“Right now, value-based care, the discussion in the country is based on equations and cost avoidance,” he said. “We need to continually put the patient at the center and ask, we know value is best determined by survival for cancer patients, how do we reach and create access to lifesaving treatments for the most cancer patients.”
Portland, Ore.-based Legacy Health is focused on delivering high quality care while preparing for what is next by taking smart risks, President and CEO George Brown, MD, told Becker’s.
“At the same time, we must hold firm on maintaining patient safety, operational stability and financial responsibility,” Dr. Brown said. “A balance of financial responsibility and measured innovation will define the choices we make through the remainder of 2025.”
In Florida, Fort Lauderdale-based Broward Health is taking steps where its community needs it most, President and CEO Shane Strum told Becker’s. It is investing in infrastructure, technology, programs and people to ensure charity care, uncompensated care and community reinvestment stay in Broward, “rather than allowing it to flow to shareholders out of state.”
“Through our Better Together collaboration with Memorial Healthcare System, we’re making investments to ensure our mission as a safety-net system is secure for our community,” Mr. Strum said. “Broward Health, and safety-net facilities across Florida, exist to serve every patient who walks through our doors.”
Weighing risks
Several leaders shared a similar sentiment: Innovation cannot come at the expense of stability or quality. For LCMC Health, it is about pacing and alignment.
“We look at new opportunities such as AI tools, strategic partnerships and alternative care models and ask ourselves: ‘Does this improve patient care? Does it strengthen our workforce? Does it make financial sense in both the short term and long term?'” Mr. Feirn said. “Rather than rushing to adopt every new solution, we pilot projects in controlled environments, measure results and scale only when the value is clear. This approach allows us to move forward thoughtfully, without creating unnecessary strain on operations.”
Artificial intelligence is one area in which Carle Health’s leadership team is prioritizing clarity, particularly regarding its pace of implementation and how to protect both the organization and patients.
“We’ve made a decision that we are not on the leading edge of a lot of the things happening,” Dr. Leonard said. “We’re a pretty quick follower, but not on that leading edge, because we want to do everything that we can to protect the patients.”
New technologies and innovations often emerge quickly, he said.
“They get a big splash,” Dr. Leonard said. “Science can be very exciting, and yet we find that if you aren’t cautious, certain safeguards aren’t always there, so we look at things a lot like a physician: How is the patient at risk if we adopt too early? Are there cybersecurity issues that haven’t been attended to?”
The concerns are not just clinical; they are also legal and business related.
“We also have to weigh that against these things being very expensive, and when you look at capital deployment, we need to be very circumspect about that and make sure they’re good investments,” he said. “The ROI not just being financial, but also raising the bar for our workforce efficiency and taking the friction out of things for patients.”
The pressure to innovate is not new, Mr. Henvey said.
“At Parkview, we have always believed in the power of innovation,” he said. “This spirit has allowed us to increase our speed to execution when evaluating new ideas, care models or facilities, for example. Yes, we need to ensure we remain stable and sustainable, but we also innovate where it makes sense for the organization in the long run. Ultimately, we believe in solutions that help deliver excellent care and create access for more people to receive that care.”
AI is one area in which ChristianaCare is investing.
“If you’re not innovating now, you’re already behind,” Dr. Nevin said. “That’s why we’re investing in AI and new care models to secure our future. AI is already helping us operate more efficiently and deliver better care, while also supporting long-term financial and operational stability.”
For Broward Health, innovating is about solving problems for families, not chasing trends. At the same time, it is focused on fiscal management.
“That gives us the stability to recruit top clinicians, fund new programs in maternal health and chronic disease, and respond when new challenges emerge,” Mr. Strum said. “The balance is clear: innovate where it meaningfully improves outcomes but hold fast to fiscal stewardship and public accountability. That’s how we protect the fate of safety-net hospitals while ensuring Broward residents receive the care they deserve.”
Finding balance
Today’s external environment is such that the business of healthcare is about managing risk, Mr. Stone said.
“Organizations that equate the risk of growing and investing as an alternative to standing still miss the point, in my view, that the riskiest approach is to hunker down and stand still,” he said. “And if we’re really going to be patient centered, you can’t wait for the proverbial storm to pass. You need to be in motion as we go.”
The decisions made now must have a short- and long-term perspective, Mr. Thomas said.
“Finding that balance between innovation and stability is a constant topic of discussion among my senior team,” he said. “It’s one of the reasons I encourage daily rounding because our physicians and staff are seeing and hearing the same things we are about the healthcare industry. Being accessible and having two-way dialogue is critical for stability within our organization.”
Dr. Brown also said Legacy Health is intentional about innovation, looking for opportunities to improve the care experience.
“We innovate to reach our strategic and operational goals, and we do it in a way that improves the care experience for both patients and providers,” Dr. Brown said. “Given the significant pressures in healthcare, we balance the drive to innovate with the realities of financial and operational stability. In practice, that means making trade-offs, holding steady in some areas so we can invest in others.”
Many leaders, Mr. Feirn among them, also noted the importance of innovation.
“Louisiana faces unique challenges like rural access, health equity gaps and disaster preparedness which require us to be creative,” he said. “By balancing innovation with financial stewardship, we can protect stability today while building a stronger, more competitive system for tomorrow.”
