Health system C-suites traditionally operated with a top down leadership structure, with executives focused on their department’s siloed performance and rarely communicating or collaborating crossfunctionally.
All that is changing. Health systems facing financial challenges, future funding cuts and a shift to value-based care need more well-rounded leaders who understand operations as much as strategy. As a result, executives see their C-suites flattening over the next five years.
“By 2030, I believe health system C-suites will become far more operational, integrated and responsive to the realities shaping healthcare,” said Joy White, DNP, RN, vice president and chief nursing officer of Legacy Health Good Samaritan Medical Center in Portland, Ore. “The political climate, regulatory pressures, workforce shortages and the shifting continuum of care, all reinforced by long-range projections from organizations like Vizient and Sg2, point to a decade of profound restructuring. As inpatient demand evolves, outpatient growth accelerates and cost pressures intensify, C-suite leaders will need to function as tightly aligned operating units rather than siloed executive roles.”
Artificial intelligence and digital transformation has given all leaders, and their teams, access to more data and insights than ever before to inform decision-making. A wave of transparency and accountability in healthcare means executive teams can see performance metrics across the board and understand the importance of meeting each goal. Those capabilities will accelerate over the next few years and transform the workforce and executive teams.
“Leaders will be expected to integrate clinical, financial, digital and workforce strategies in real time, with an emphasis on execution, adaptability and system-level thinking,” said Dr. White. “Ultimately, the C-suite of the future will be designed less around titles and more around the capability to lead complex, independent work.”
Darrell Bodnar, CIO of North Country Healthcare in Lancaster, N.H., has a similar outlook. He sees healthcare C-suites shifting from traditional roles and siloes to a more integrated, operationally embedded leadership team nimble enough to respond to any challenges.
“Titles will matter less than capabilities, with CIOs, CMIOs, CFOs and COOs increasingly co-owning strategies around digital enablement, workforce sustainability, access to care and clinical outcomes,” he said. “For rural health systems in particular, C-suite leaders will need to be fluent in technology, finance and operations while simultaneously leveraging digital platforms, AI, virtual care and shared services not as innovations, but as necessities and tools for survival.”
He also sees each C-suite leader taking accountability for the performance of the entire organization, understanding the interdependence of each department and working together with the “systemness.”
“The future C-suite will spend less time managing departments and more time orchestrating their entire healthcare ecosystem,” said Mr. Bodnar. “We are already seeing this occur today and suspect the trend will continue. It will be about aligning providers, payers, vendors, regulators and communities around simplicity, reliability and measurable value while maintaining a relentless focus on patient safety, staff experience and long-term financial resilience. The game is changing, and it will continue to change.”
Salim Hayek, MD, chair of the department of internal medicine and chief transformation officer of The University of Texas Medical Branch at Galveston thinks the expanding aging population and imperative for value-based care will dissolve siloes and force traditionally divided administrative, clinical and academic leadership to unite.
“Success requires an integrated enterprise leadership team, a model we are implementing at UTMB to ensure that strategy, capital, and workforce decisions are fully synchronized across our clinical and academic missions,” said Dr. Hayek. “In this model, transformation is not a department; it is the primary function of the executive team. We are focused on scaling novel care models and modernizing physician competition.”
He underscored Mr. Bodnar’s point about technology and AI, calling on health systems to reframe AI accountabilities to go far beyond the IT department. AI is becoming a core component of executive governance and system functionality.
“Future leaders must personally oversee the integration of AI into operations, ensuring safety, equity and performance are managed from the top down,” said Dr. Hayek.
While executives become more facile with all aspects of the C-suite, leadership is expected to remodel for more dyads and dual roles. At Sinai Chicago, a safety net hospital in one of the largest cities in the U.S., the leadership team recently integrated the COO role into all other C-suite titles instead of hiring one individual to take on those responsibilities.
“We’ve made an intentional effort to distinguish hospital clinical operations from physician enterprise and business development, ensuring each vital area receives the focused leadership, priority and strategy required to strengthen our business,” said Ngozi Ezike, MD, president and CEO of Sinai Chicago. “C-suite transformation will also require continued focus on partnership and collaboration.”
More clinicians are taking on leadership roles as well. Their clinical background informs decision-making at the top, and administrative leaders can learn to incorporate the patient perspective into every strategic move.
“One of the most exciting C-suite transformations is the growing number of physicians and clinicians in chief executive and chief operating officer roles,” said Matthew Ducsik, vice president of Providence Clinical Institutes at Providence. “Research is starting to illustrate the significant transformational potential within healthcare, including clinical excellence, provider satisfaction, innovation and financial and operational success.”
Mr. Ducsik sees administrative leaders continuing to function as strategic thinkers and operational partners to their clinical counterparts.
“Organizations should also be intentional as to how they develop their clinical leaders through both formal programs and informal relationships; true investment in structured clinical leadership development programs remains a gap that must be addressed,” said Mr. Ducsik.
