For many health systems, internal audit has historically functioned as a rearview mirror, focused on compliance, controls and retrospective assurance. At Fort Wayne, Ind.-based Parkview Health, that model is evolving as leaders look for clearer, more integrated views of enterprise risk in an increasingly volatile operating environment.
Since joining Parkview in 2023, Holly Lee, vice president and chief audit executive, has worked to reposition internal audit as a strategic partner to executive leadership. The centerpiece of that shift is an integrated assurance model that aligns enterprise risk management and internal audit into a single, coordinated framework.
Parkview is a nonprofit health system serving northeast Indiana and northwest Ohio. Lee said internal audit’s purpose is tightly connected to the organization’s simple, yet powerful, mission.
“We’re focused on improving health and inspiring well-being,” she said. “For internal audit, our role is to provide assurance and insight that really helps Parkview achieve its mission from a responsible and ineffective perspective.”
Building a single, enterprisewide view of risk
One of Ms. Lee’s first priorities was addressing fragmentation in risk oversight. Like many health systems, Parkview had multiple assurance and risk-related functions producing valuable but disconnected insights. The lack of alignment made it harder for leaders to see how risks intersected across the organization.
“The real idea is simple: we want to move beyond their traditional internal audit assurance role and create a more connected approach to risk oversight for the organization,” Ms. Lee said.
By aligning enterprise risk management within the internal audit function, Parkview aims to give leaders a clearer, consolidated picture of organizational risk instead of the fragmented reports they previously received.
“It’s like coordinating care for a patient with multiple specialists. If each doctor works in isolation, the patient runs a risk of getting conflicting treatments,” she said. “But when we share information and follow a care plan, outcomes generally improve and risk goes down.”
The same principle applies at the enterprise level. By treating risk as a systemwide condition rather than a set of isolated issues, Parkview has reduced duplication across oversight activities and strengthened leadership confidence in strategic decisions.
“Ultimately, the payoff from their work that we did last year is that we end up with a clear vision of emerging risk,” Ms. Lee said.
Shifting internal audit from retrospective to forward-looking
One of the most difficult challenges facing health systems today is balancing growth and innovation with limited resources. That tension is especially acute as organizations pursue large-scale initiatives such as ERP modernization and AI adoption.
Rather than acting as a brake on innovation, Ms. Lee sees internal audit as helping leaders move forward responsibly by providing assurance that major initiatives are governed well and aligned with organizational priorities.
“Our work helps leadership clearly see both risk and opportunities so decisions are informed and progress supports quality, compliance, and trust,” Ms. Lee said.
With constant pressure and competing demands, maintaining a clear structure tied to organizational strategy is what keeps internal audit focused and effective. That alignment allows the audit function to make disciplined choices about where to invest time and resources.
“When challenges come along, what really keeps us grounded is making sure we’re aligning back to those strategic priorities for the organization,” Ms. Lee said. “The best opportunity for growth in healthcare doesn’t necessarily start with technology or expansion. It really starts with readiness and I think that’s because in internal audit, we see some really great ideas struggle. Not because the strategy was wrong or the technology wasn’t there, but because the foundation that it is built on isn’t strong enough. The biggest growth areas are investing in people, building a culture of accountability and then turning data insights into insights that actually drive decisions.”
As Parkview looks ahead to 2026, Ms. Lee said the internal audit function is becoming more proactive, with a focus on helping leaders anticipate change rather than react to it. The team is prioritizing data, agility and resilience as healthcare headwinds intensify.
“We’re advancing our analytic capabilities for auditing so that we can provide leadership with real time insights into the financial, operational, and compliance risk that come along with those headwinds for 2026 and beyond,” Ms. Lee said. “We’re building flexible audit plans and integrated assurance processes so that we can pivot quickly to anticipate and respond to evolving and emerging risk. For resilience, we’ll really focus on strengthening cybersecurity as digital health expands and planning for workforce shortages that continue to challenge us. We’re embedding risk management into those strategic decisions.”
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.
