Health system leaders are heading into 2026 with a familiar mandate — grow, stabilize margins and invest for the future — but this year seems especially unpredictable and transitional.
From federal funding shifts and tariff pressures to workforce shortages and capital constraints, executives say long-range planning has become more complex and less certain. Policy changes at both the state and federal level continue to reshape reimbursement and labor dynamics, while inflation and technology investment demands add new layers of risk to already thin margins.
In response, C-suite teams across the country are rethinking how they define growth and resilience. Rather than betting on rigid multiyear plans, many are leaning into scenario modeling, operational discipline and adaptive strategies designed to flex as conditions change.
“We are all continually thinking about whether our priorities still align with our vision for the future,” said Bess Wildman, vice dean of academic administration and finance at University of Chicago Medicine. “For many, we have followed a formula that ensures revenue growth outpaces expense growth by leveraging efficiency, technology and economies of scale. We are living in interesting times and our future outlook is riddled with uncertainty and unknowns.”
Healthcare policies are fickle and often used as a bargaining chip in major legislative overhauls and budgets. It’s hard for healthcare leaders to predict the financial and operational impact of federal funding cuts, government shutdowns and economic policy shifts, including growing tariffs and work visa constraints.
In addition to the every-changing state and federal policies, health system executives are still contending with workforce shortages, union strife, inflation and capital demands.
“It is very hard to have confidence in how these variables play out in a long-range plan,” said Ms. Wildman. “Because of this, I like to think that our plan is now modular growth, meaning we are not changing direction; growth is a key building block to our strategy. We are doing more scenario modeling on the front end of big decisions and we are more closely monitoring for early signals that we should change or slow something down.”
UChicago has also doubled down on operational effectiveness and executives are spending time developing new ways to add value and remove costs.
“The great news is that the uncertain times have made our physicians and leaders dig into this work,” she said. “I believe that we are able to drive change which may have been more difficult in a stable environment.”
This sentiment is shared by health system leaders and executives across the U.S., viewing 2026 as a year of transformative change where finding the right balance between scalable growth and financial stewardship is paramount. For leaders in rural and urban markets alike, guarding against workforce shortages and building adaptive, resilient teams will be the difference between thriving and struggling in the future.
“We are entering what futurists describe as the transition generation, an era marketed by accelerated and complex change, overlapping systems and the need to continuously evolve,” said Roko Miles, executive director of operational excellence at Northeast Georgia Health System in Gainesville. “Long-term stability will no longer come from rigid structures, but from our ability to continuously learn, adapt, integrate and deploy capabilities and innovation where they create the most value.”
Northeast Georgia Health System’s leadership team is adopting lean as an operating management system to drive accountability and high performance in the future.
“By strengthening how we see and think differently about where value is created, where we are going and the evolving needs of the communities we serve, we position our organization to sustain performance today while enabling meaningful, resilient growth for the future,” she said.
The fast pace of change within the “dynamic environment” is driving leaders at Cincinnati-based Bon Secours Mercy Health to focus on execution of their mission-based strategy with agility and innovation as “culture must-haves,” according to Nikki Carter, chief strategy officer of U.S. markets.
“Agility is important for all levels of the organization to embrace change and adopt best practices,” said Ms. Carter. “Innovation is particularly important for leaders to identify solutions and opportunities for differentiation through internal resources or in partnership with external innovators.”
Proactive innovation and care coordination will increase access to care and service growth while meeting the needs of the community. But even through this transformational time, the faith-based system’s mission of “extending the compassionate ministry of Jesus” guides the financial and operational decision-making around revenue and service diversification.
Mullica Hill, N.J.-based Inspira Health is undergoing a similar innovation-based culture change, anchored in its mission with patients and employees at the center of every decision made. Warren Moore, president and COO of Inspira, sees a big opportunity to transform healthcare delivery and sustainability through operating more as a single organization.
In the next year, the health system is focused on strengthening systemness with a community-first, tech-enabled approach to spread healthcare delivery beyond the walls of the hospital.
“We are doing this by leveraging real-time data, AI-driven insights and disciplined efficiency practices to empower our health system’s leaders to manage resources as if they are running their own small businesses,” he said. “In today’s dynamic healthcare environment, both agility and strategic collaboration are essential to expanding access and improving the patient experience for all.”
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.