COOs in healthcare have seen their role gradually evolve due to the advancement of technology, a pandemic, and issues like workforce shortages.
Becker’s spoke with 16 COOs from different health systems on how the role has changed over the years.
Question: How has the COO role in healthcare evolved over the last decade?
Darryl Elmouchi, MD. COO of Providence (Renton, Wash.): I think we’ve seen two significant changes in the COO role over the past decade. The first has to do with health systems getting larger and more complex. As this has occurred, COOs have had to become even more of an orchestrator of high-performing teams as opposed to focusing on specific tasks and projects. Recruiting, aligning and empowering the most talented leaders is paramount. Additionally, with so many challenges related to the pandemic, workforce shortages, reimbursement challenges and policy uncertainty, a modern COO must be much more flexible and adaptable in their approach. What worked in the past is unlikely to work going forward. This is the new paradigm, and for me, it’s exciting.
Fritz François, MD. Executive Vice President, Vice Dean and Chief of Hospital Operations at NYU Langone Health (New York City): Over the last decade, the healthcare COO role has evolved to proactively manage uncertainty by leveraging real-time predictive analytics to provide system-wide value. At NYU Langone Health, we continuously track performance and improve care quality at every patient interaction. Generative AI allows us to do this more efficiently while involving more cross-functional teams to solve complex problems, converting headwinds into tailwinds.
Bryan Croft. Executive Vice President and COO of Cedars-Sinai Medical Center and CEO of Cedars-Sinai Marina del Rey Hospital (Los Angeles): More than ever, COOs need to leverage new approaches and technologies to address complex strategic and logistical issues, and they must be effective communicators up and down the organization. It is necessary to use a variety of communications tools and techniques, including in-person meetings, email, and video messages to ensure high-priority issues are heard, understood, and ultimately executed.
Given the nature of the world we live in, COOs must be ultra flexible in dealing with internal and external disrupters that challenge strategy, operations, and finance. COVID-19, the national IV fluid shortage last fall and major California wildfires earlier this year are just a few examples of major disasters that required adaptability and patience at Cedars-Sinai.
A hardline focus on patient capacity, flow and throughput also has taken a much more prominent role in day-to-day decisions. Equally pressing are the challenges of managing the crossroads of market pressures and regulatory demands on the organization.
Tonya Johnson, DNP, RN. Health System COO of MU Health Care (Columbia, Mo.): The COO role has traditionally focused on operational efficiency and standard work, which remain essential amid today’s financial pressures, workforce shortages and throughput challenges. But success now also requires broader skills. In a highly matrixed organization like University of Missouri Health Care, COOs must collaborate across teams, foster alignment, drive strategy and build high-performing groups. By removing distractions and charting a clear path forward, an effective COO engages stakeholders and adapts past experience to meet the demands of a continually changing health care landscape.
Kimberly Guy. COO of BayCare Health System (Clearwater, Fla.): The chief operating officer role in healthcare has expanded over the past decade, evolving from a focus on operations into a broader strategic leadership position. Beyond overseeing logistics and day-to-day functions, COOs now play an integral role in shaping organizational direction and driving innovation.
Today’s COOs balance efficiency with growth, navigate talent recruitment, retention and resource constraints, and adapt to rapid technological and regulatory changes—all while focusing on positive patient outcomes. The work spans everything from workforce strategy to digital transformation, requiring agility, foresight and a deep commitment to mission.
We’re driving transformation and aligning every move with our true north: exceptional patient care.
Clarence Sevellian. Executive Vice President and COO of Prisma Health (Greenville, S.C.): As with many things in healthcare, the role of the COO has really come full circle within the last decade. Historically, the COO was expected to take care of the day-to-day operations, be the CEO’s right hand, drive overall systemness and to be the glue for the organization. Then, the era came where the COO was either being phased out or blended with other C-suite roles, largely driven by financial constraints.
Today, the role of the COO continues to play a vital role in healthcare. With the CEO role involving strategy, focusing on merger and acquisition opportunities and managing external engagements (politics specifically), the COO must continue to focus on the day-to-day operations, drive operational performance and building systemness. However, in addition to perfecting operations, the COO now has to be a visionary COO that focuses on technology, innovation (AI), driving growth, building culture, navigating change, building a strong workforce and being the glue in other ways to make the difference and to advance their organizations for the future.
Kelly Elkins, MPH. COO of MaineHealth (Portland, Maine): The role of the COO has shifted dramatically over the past decade. Where the focus used to be primarily on execution—managing operations, cost, and throughput—today’s COO is a strategic partner to the CEO, accountable for transformation, workforce strategy, digital innovation, and system integration. The modern COO must balance operational rigor with adaptability, lead across markets and communities, and play a visible role in shaping culture and strategy. In short, the COO has evolved from being the steward of operations to being the architect of transformation and a co-pilot of organizational vision.
Jason Fahrlander. COO of Community Health Network (Indianapolis): Traditionally, COOs have been responsible for managing the business, but now I find growth and development to be equally as important in my role. Strategic growth is an imperative as we seek size for relevance.
Eric Deaton. COO of Ballad Health (Johnson City, Tenn.): The role of a COO in healthcare has shifted dramatically over the last decade. It’s no longer just about service line growth and operational metrics, it’s about engaging with team members in a deliberate way, understanding their needs, and making sure they have the tools and support to provide the best possible care.
Our workforce is multi-generational, and the COVID-19 pandemic heightened the challenges of workforce development, making it even more important to understand what motivates each individual. We must also prepare the next generation of healthcare professionals through strong succession planning, showing them a clear path to a successful career. Despite the headwinds our industry faces, I believe that if we stay grounded in our people, mission, and values, our organizations will continue to endure and thrive.
Tina Garrison. COO of SSM Health’s St. Louis and Southern Illinois Region (St. Louis): Over the past decade, the healthcare COO role has undergone a significant transformation, shaped by evolving industry demands and accelerated by recent global and national healthcare challenges including the pandemic, staffing challenges, and changing care delivery models.
Today’s COOs must be operational leaders and strategic change agents who drive innovation and agility across hospitals and physician enterprises through cross-functional collaboration. As a Regional COO supporting nine hospitals, I’m called to lead initiatives that fast-track change, streamline operations, and address increasingly complex patient needs and care utilization.
The role now requires a regional lens, I continuously balance system-wide priorities with local realities, while ensuring expert voices are included in decision-making. One of the most significant shifts has been the growing need for this broader, interconnected view as health systems navigate a more dynamic and multifaceted landscape. Above all, COOs serve as trusted partners to clinical and executive leaders, aligning strategy with thoughtful execution to support long-term success.
Brett McClain. COO of Sharp HealthCare (San Diego): Over the past decade, the role of the COO has evolved significantly, expanding from specializing on internal technical operations to focusing on the care of staff, the health of communities, and operationalizing care models for long-term financial viability.
At Sharp, we prioritize the well-being of our 20,000 staff members and 4,500 affiliated physicians, and have expanded programs like Sharp Best Health, our employee wellness program consisting of systemwide initiatives, an interactive health portal, and countless site-based wellness and employee assistance programs.
The COO is the conduit between organizational strategy and front-line execution. As health systems become increasingly integrated, the COO assures that the community receives consistent care and experience regardless of the care delivery site. The COO must assure that the employee voice is heard when implementing new strategies, particularly those that impact workflows and job satisfaction. This is particularly essential in the development of new technologies promising to make work easier, which is not always true.
Kathy Donovan. COO of Hospital Sisters Health System (Springfield, Ill.): The COO role in healthcare has become increasingly multifaceted. While operational leadership remains foundational, COOs must also have the ability to unify functional areas across the organization, aligning care delivery and operational efficiency with financial planning and strategic priorities.
As the information technology landscape rapidly evolves, COOs are becoming increasingly involved in driving digital transformation, partnering with the Chief Information Officer (CIO) to lead technology-based initiatives that improve patient care and streamline operations.
Although the responsibilities of healthcare COOs will continue to shift in response to industry changes, a core expectation remains: they must drive transformation while effectively navigating both internal complexities and external pressures.
Jennifer Eslinger. COO of Rochester Regional Health (Rochester, N.Y.): Healthcare is complex and highly dynamic. Over the past decade, the role of the Chief Operating Officer (COO) has become more complex and multidimensional than ever before. This means being equally effective in the boardroom communicating vision, aligning with governance priorities, and influencing long-term strategies on the front lines, where operational decisions directly impact patient care, staff performance, and service delivery.
With growing pressures from regulatory shifts, evolving payment models, workforce shortages, and rising patient expectations, COOs must be agile, data-driven, and culturally attuned. Their ability to translate external trends into actionable results, while fostering a culture that aligns with purpose and drives execution, makes them essential to an organization’s ability to adapt, compete, and thrive.
Joel Helmke, MSHP. COO and Senior Vice President of Cancer Services at Fox Chase Cancer Center (Philadelphia): I would say that beyond managing people and processes, we now manage data. The data revolution has arrived, and gratefully the AI revolution that is now occurring will allow us to leverage that data efficiently.
The amount of available data seems to grow exponentially, so the ability to mine that data to drive insightful decision making around benchmarked resource management or strategic investments to grow the organization is critical.
The data revolution has arrived, and gratefully the AI revolution that is now occurring will allow us to leverage that data efficiently.
Carol Gomes, MS. CEO and COO of Stony Brook University Hospital (Stony Brook, N.Y.): The health care sector has experienced many significant challenges over the past several years. Increased spiraling costs associated with medical supplies, pharmaceuticals, medical equipment, and employee compensation have all contributed to financial challenges, including the ability to address a deluge of insurance denials in a highly competitive market.
In addition, with healthcare workforce challenges, it is imperative to manage an efficient, effective, compassionate and safe enterprise while continuing to provide tertiary and quaternary services for all patients. As a result, the COO role has evolved to address not only operational challenges, but also strategic imperatives to ensure viability and sustainability within a health system.
This entails a high-level focus on maximizing workforce efficiency, leveraging technology to support the workforce and ensuring that areas of operational focus are strategically aligned with organizational goals to achieve maximum level performance. Post-pandemic, these challenges have been severe, and as a result, the COO role is significantly more prominent and remains vital to ensure viability and sustainability while continually improving healthcare service delivery.
Monica Wharton. COO of Methodist Le Bonheur Healthcare (Memphis, Tenn.): Over the last decade, the healthcare COO role has shifted from primarily overseeing hospital operations to driving systemwide transformation and growth. Today’s COOs lead enterprise-wide digitization, strengthen financial performance under margin pressures, and navigate workforce shortages with a people-first approach. They have become visible, strategic partners who balance operational excellence with visionary leadership in a rapidly evolving healthcare landscape.
