From explaining workforce reductions to service line closures to ongoing payer negotiations, hospital CEOs are being asked to deliver difficult news more often than ever.
The hard conversations are not going away.
Nearly 40% of hospitals were already losing money before many federal policy shifts took hold, and compounding cuts to 340B payments, site-neutral reimbursement and Medicaid coverage stand to make 2027 more challenging still. Dozens of hospitals have closed departments or ended services, while more than 60 systems have cut jobs so far in 2026.
Becker’s connected with nine hospital CEOs, from rural critical access hospitals to large academic health systems, to learn how they approach explaining difficult decisions to their communities.
For some, the test has come at the negotiating table. When Columbia, Mo.-based MU Health Care reached an impasse in its negotiations with Anthem Blue Cross Blue Shield in 2025, the system agreed to publicly share its position before the Missouri Senate to create greater transparency and accountability, CEO Ric Ransom said.
“We ultimately reached an agreement to restore in-network access, and my biggest takeaway for other CEOs is simple: communicate openly and transparently, stay focused on the people you serve and don’t shy away from uncomfortable situations if they can help move you toward a solution,” Mr. Ransom said.
That willingness to go public with payer tensions was shared by Brenda Reetz, BSN, RN, CEO of Greene County General Hospital in Linton, Ind., who has spoken openly about her organization’s ongoing payer challenges, including sharing that the hospital has been operating under a breach notice with Anthem tied to ongoing claim payment disputes. Ms. Reetz said at a small, county-owned hospital — the community’s only one — the public deserved an honest explanation.
“These issues are difficult and sometimes uncomfortable to discuss publicly, but our community has a right to understand the pressures facing their hospital,” she said. “My advice to other CEOs is simple: be transparent, explain the ‘why,’ and trust your community with the truth.”
At Madelia (Minn.) Health, President and CEO David Walz has confronted the challenge from a different direction. As a critical access hospital, Madelia Health has closed services and reduced others as a result of the financial pressures facing rural healthcare. Some changes have directly affected employees and community members — and they were not made lightly, Mr. Walz said. He added that his approach centered on being transparent and empathetic.
“I believed our caregivers and community deserved to hear the facts directly from leadership rather than through rumors or speculation,” he said. “We explained why the decisions were necessary, acknowledged the impact they would have, and, importantly, continued to communicate that these changes were about positioning Madelia Health to remain here and serve our community for the long term.”
He also found that a single announcement was not sufficient.
“It has to be an ongoing conversation with caregivers, providers, community leaders, patients, and the broader community,” Mr. Walz said. The lesson he would offer another CEO: “When you have to deliver difficult news, don’t hide from it. Be visible, tell the truth, explain the ‘why,’ and communicate with empathy. People may not agree with every decision, but they are much more likely to understand it when they know their leaders are being honest with them and are working alongside them toward a better future.”
What happens when that transparency comes too late is illustrated by the experience at Jackson Hospital and Clinic in Montgomery, Ala. John Quinlivan, the hospital’s president and CEO, came into the role during a bankruptcy that had been preceded by a period in which leadership had continued to reassure staff and the community that everything was fine.
“Obviously, that wasn’t true,” Mr. Quinlivan said.
Assuming leadership during the bankruptcy, the team knew the only way to earn back trust was to be fully transparent, he said.
“We gave dozens of staff and community presentations where we shared the brutal truth — all of it,” Mr. Quinlivan said. “We lost some staff and patients who were concerned by the reality of our situation but, as we now successfully emerge from bankruptcy and reorganize the hospital, we once again enjoy strong community support and a level of trust only honesty and transparency could create.”
The executives navigating specific public crises share a thread with those who have built communication frameworks in advance of difficult moments: Preparation shapes the outcome as much as the message.
Sandra Scott, MD, CEO of New York City-based One Brooklyn Health System, emphasized that effective crisis communication must be designed before a crisis arrives.
“Leaders must identify every stakeholder group in advance, determine the right sequence, and choose the right communication method for their organization,” Dr. Scott said. For key stakeholders such as elected officials and regulatory agencies, her advice is direct: “Make sure they hear it from you before they hear it from someone else. A direct call or advance briefing gives them context, rationale, and the opportunity to ask questions before the issue reaches them through another channel.”
Michael Wagner, MD, president and CEO of Providence, R.I.-based Care New England Health System, said successfully delivering difficult communications starts with planning and internal alignment, involving the communications team early.
“We consider the sequencing of our audiences: the board, team members, stakeholders, and then the public,” Dr. Wagner said. “It is important to be the primary source of our own news, communicating honestly and with the necessary context as to why we are taking this action, and to do it without delay.”
Many CEOs have also navigated public conversations about workforce reductions and financial transformation efforts, including Peter Banko, president and CEO of Springfield, Mass.-based Baystate Health. His framing centers on removing self-interest from the equation.
“My approach was to communicate with complete transparency, acknowledge the human impact with kindness and compassion, and clearly explain not just what we were doing, but why it was necessary and not optional,” Mr. Banko said. “The lesson I would share with another CEO is you must let go of what is comfortable and make the tough decisions. This is not about you and not about now; this is about protecting the mission for future generations.”
Dara Bartels, CEO of Mile Bluff Medical Center in Mauston, Wis., described the discipline of building and holding to a small set of key messages during difficult moments, relying on legal counsel and her leadership team to ensure accuracy and consistency.
“The biggest lesson I’ve learned is that people may not always agree with a decision, but they are far more likely to trust leadership when they feel they are being told the truth,” Ms. Bartels said. “My advice to another CEO would be to communicate early, communicate clearly, and remember that credibility is built through consistency, candor, and respect, especially during difficult moments.”
For Deborah Visconi, president and CEO of Bergen New Bridge Medical Center in Paramus, N.J., the foundation of any difficult communication is the trust that predates the crisis.
“In difficult moments, people know when you’re speaking from a script instead of speaking to them, and that’s why being human matters,” Ms. Visconi said. “My advice to another CEO is to communicate early, don’t hide behind corporate language, and never underestimate the importance of the trust you’ve built long before a challenge occurs. That trust is what carries an organization through the moments when the message isn’t easy.”
