Becker’s asked four health system strategic leaders to pick one operational process systems must rethink in 2026.
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Editor’s note: Responses have been lightly edited for length and clarity.
Question: What is one legacy operational process that health systems must fundamentally rethink in 2026?
Juan Guzman. Chief Operations Officer, IU Health West Hospital (Avon, IN): Most health systems still operate as if volume equals success – procedure volumes, admissions, clinic visits, etc. This mindset could now actively work against systems looking to become more financially sustainable because not all volume is created equal. With labor constraints, payer mix deterioration, burnout, and the social complexities our patients bring into our four walls, health systems will need to shift from this mindset to one that deeply understands contribution margin by service line, staffing sustainability, clinical appropriateness of admission and how these are balanced to meet the needs of our patients and communities. Redesigning how health systems rewrite and measure growth & productivity KPIs will be important. Health systems that simply chase volume in 2026 will look busy but may get weaker long-term. Success will be defined less by how much volume is within the hospital, clinics or ASCs, and more by how wisely scarce labor and resources are deployed.
David Sylvan. Chief Strategy, Innovation and Marketing Officer, University Hospitals (Cleveland, OH): Candidly, health systems need to rethink the fundamentals of all of their operating assumptions, but if I had to select one that’s readily identifiable with a reasonable expectation for success, I would stress the need to scale the automation of note taking and data capture – not just the clinical encounters but the optimized reuse of AI-generated notes to facilitate billing; quality and research. This will simultaneously have a positive impact on clinician burnout while reducing errors and accelerating revenue recognition
Dawn Thompson. Chief Strategy Officer, Advanced Diagnostics Healthcare System (Houston, TX): The single legacy operational process we need to rethink is simple:
Annual, department driven budgeting. Traditional budgeting was built for a fee for service, stable demand world.
Todays reality- margin compression, labor volatility, site of care shifts, and value-based risk -actively works against performance. Health systems need to move toward dynamic, service-line and capacity-based financial management.
A few Key problems:
– Using last years assumptions, despite volume changes and payer mix changes
– Silo- departments optimizing their own budgets and not seeing the big picture within the enterprise
– Capital and labor unpredictability and lack of fast action towards demand
Health systems that continue to budget from the past and based on last year’s performance will struggle to fund growth, absorb risk, or execute strategy.
Alan Kumar, MD. Chief Operating Officer, Powers Health (Munster, IN): Forward-thinking health systems will need to explore the effective integration and balance of artificial intelligence with traditional human resource needs and allocations. Healthcare business revenues continue to be negatively impacted by adverse policy changes and third-party entrants into our already slim profit margins. Health systems will be better positioned to offset these revenue challenges by creating staffing efficiencies through AI, while still maintaining positive patient experiences and outcomes.
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