Let’s start with one fundamental truth: Healthcare costs too much.
There are many reasons why. Rising pharmaceutical costs, technology, labor shortages, an aging population and regulatory requirements all contribute. But there is another cost that healthcare organizations themselves have some ability to address: overhead and administrative costs.
Studies estimate that administrative expenses account for 15% to 25% of U.S. healthcare expenditures [1]. Not all that spending is unnecessary, and not all of it is overhead. Healthcare is extraordinarily complex, and good management matters. But if we are serious about making healthcare more affordable, we should be willing to ask a simple question: Does every leadership responsibility require a separate person, a separate layer and a separate job? I suggest healthcare rediscover an old idea from sports: the player-coach.
The player-coach
The player-coach was once part of professional sports. The Boston Celtics provide one of the best examples. When legendary Celtics coach Red Auerbach stepped down in 1966, Bill Russell, one of the greatest players in NBA history, became both the Celtics’ starting center and head coach. In 1968, Russell’s Celtics won the NBA championship. They did it again in 1969, making Russell the only NBA player-coach to win multiple championships in that dual role [2]. The Celtics returned to the concept a decade later. Dave Cowens, another Hall of Fame center, served as player-coach during the 1978-79 season. The outcome was not the same. But as a young Celtics fan at the time, I remember watching and wondering: Why didn’t more teams have a player-coach?
A year later, the role was gone from the Celtics, and it has not returned to the NBA since. The player-coach model disappeared as professional sports became more complex and specialized. Coaching staffs expanded dramatically and analytics, scouting, training and management became more sophisticated. Playing and coaching at the same time came to be viewed as too difficult. Healthcare has followed a similar path.
Overhead
Healthcare has become more complicated, and management has grown along with it, which, in many ways, is necessary. Today’s healthcare organizations need expertise in quality, finance, technology, compliance, human resources, strategy and operations. However, specialization tends to create more specialization. Organizations add managers, then directors to coordinate the managers, then vice presidents to coordinate the directors. Additionally, organizations add organizations and thus additional layers are created between the entity delivering the care and the markets or the system above. Each addition may be perfectly rational on its own. Collectively, however, those additions can create greater organizational distance, more handoffs and higher overhead.
In my humble opinion, overhead is a big deal. However, it has been difficult to measure and there is no gold standard for measuring overhead across healthcare organizations. That is an opportunity. Yet there seems to be little appetite to take it on.
What does a player-coach do?
A player-coach does not mean a hospital president spends half the week staffing an operating room. Nor does it mean every department director carries the same workload as the people they supervise. It means leaders remain meaningfully connected to work, not as projects, as a core part of their work. The examples are numerous:
- A physician executive might continue seeing patients one day each week.
- A nursing leader might regularly participate in clinical shifts.
- A quality leader might personally lead improvement projects rather than only reviewing dashboards about them.
- An information technology leader might still analyze data, build solutions, or participate directly in technical work.
- An administrative leader might directly manage an important operational project instead of assigning every initiative downward.
- An academic leader might be actively involved in a student research project or teaching a class.
The model goes from department chairs and directors all the way to senior executives. The amount of time a coach plays will vary as it might be 5%, 10% or 25%. The percentage is less important than the principle that leaders need some meaningful playing time with the team.
This is not micromanagement
There is an important distinction between being a player-coach and being a micromanager.
Micromanagers get close to the work because they may not trust other people to do it.
Player-coaches get close to the work because proximity helps them understand it and contribute to it. A micromanager takes decisions away from employees. A player-coach should make employees more effective because the leader understands the obstacles they face.
Player-coaches should not become bottlenecks. They should not undermine managers who report to them. And they should not insert themselves into every decision. Their involvement should make the organization faster, not slower.
The player-coach as one way to reduce overhead
The economic argument may be the most important one. Administrative expense represents an enormous component of American healthcare spending. Chernew and Mintz estimated administrative expenses at $600 billion to $1 trillion annually, while other research has identified administrative complexity as one of the largest categories of potentially wasteful healthcare spending [1,3].
No healthcare organization can eliminate management and leadership. Nor should it. But every healthcare system is asking some version of the same question: How do we reduce overhead without harming patient care?
The player-coach model is one answer. It will not solve the cost conundrum, but it will be an important step towards reducing overhead. Candidly, reducing overhead in this approach will be pennies proportionately, however, it is still waste, and it adds up and it moves a culture toward efficiency.
Healthcare organizations could deliberately design more hybrid leadership roles. When leaders leave departmental positions, rather than automatically replacing the job exactly as it existed, organizations could ask whether the role can be redesigned. Could someone both play and coach? Could leadership responsibilities be combined with meaningful operational, clinical, technical, or academic work? Could a layer be eliminated altogether?
Every organizational layer brings coordination costs: meetings, reports, emails, approvals and handoffs. Reducing layers can therefore do more than reduce expense. It can shorten the distance between a problem and the person empowered to solve it.
Why don’t we see more player-coaches?
There are legitimate reasons healthcare and professional sports have moved away from player-coaches. As organizations and industries have become more complex, leadership roles have become larger and more demanding. It can be difficult to perform two jobs well.
But there is another reason. We have designed career advancement around moving people further away from the work. A great nurse becomes a manager and stops providing nursing care. A great physician becomes an executive and stops seeing patients. A talented analyst becomes a director and spends more time reviewing other people’s analyses than producing one. Success gradually moves people farther from the activities that helped make them successful and we should challenge that assumption.
Organizations can identify specific leadership positions that are appropriate for a player-coach model and intentionally define the portion of time devoted to direct work. I would argue that every senior leader or C-suite position should be a player-coach. Technology and artificial intelligence may make this even more feasible. If technology reduces the administrative burden on leaders, we should not fill that time with more meetings, more reports and more administrative work. We should give some of that time back to the actual work of the organization.
Bring back the player-coach
Healthcare leaders do not all need to be on the metaphorical court or field every day. And the complexity of modern healthcare means we will always need talented people whose primary expertise is management. But we have allowed leadership and work to become too separated. If healthcare wants to become more affordable, we cannot look only to others (insurers, pharmaceutical companies, government, etc.) for savings.
Healthcare organizations must examine their own structures as well, and there is no better place to start than overhead.
Healthcare needs great coaches. To reduce costs and reduce overhead, we need more of those coaches back on the field playing alongside their teams.
References
- Chernew M, Mintz H. Administrative Expenses in the US Health Care System: Why So High? JAMA. 2021;326(17):1679-1680.
- https://www.nba.com/news/bill-russell-hall-of-fame-profile-2021 accessed on 8/10/26.
- Kocher RP. Reducing Administrative Waste in the US Health Care System. JAMA. 2021;325(5):427-428.
Maulik Joshi, DrPH, is the president and CEO of Meritus Health and president and professor at Meritus School of Osteopathic Medicine.
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.
