The health system C-suite continues to evolve, as organizations streamline leadership by eliminating or combining roles, and by restructuring leadership teams amid industry headwinds. Against this backdrop, the COO role is also changing, with leaders taking on more strategic responsibilities while continuing to oversee day-to-day operations across their systems.
In conversations with Becker’s, Eric Stevens, COO of Roseville, Calif.-based Adventist Health, and Rick Majzun, president and COO of Palo Alto, Calif.-based Stanford Medicine Children’s Health, discussed how they are balancing this growing scope and where the COO role fits in the modern C-suite.
Mr. Stevens began serving as COO on March 5 and will continue to serve as president of Adventist Health’s Northern California network, a role he has held since December 2023. He said his roles are being shaped as Adventist, a 27-hospital system serving communities on the West Coast and in Hawaii, has embarked on a process to, where appropriate, move from siloed, site-specific leadership to a geographically aligned model.
“If I have a young leader who’s the president of a hospital and their interest stops at their property line, we lose opportunities to care for people,” Mr. Stevens said. “We lose opportunities to grow and build our business.
“So in places where we have multiple offerings in a community or in adjacent communities, having a group of really good, well-thought-out operators that passionately can run a hospital — that all roll up to a single CEO that looks over that geography — creates a lot more gap-closing, continuity of care and redefining, largely, how we look at the care that we provide in a large geography. To not be confined by a series of parts and pieces, but in a more congruent, cohesive fashion.”
Building on this approach, Mr. Stevens said Adventist is working to create leadership structures that are both more effective and less expensive as the system, like other organizations, faces downward pressures on earnings due to higher costs. He noted that in doing so, the system is considering each role’s responsibilities, how they have previously functioned and the strategies behind them.
These structural changes mean COOs — and any other roles directly connected to operations — must take a deeper look into the operational effectiveness of the organization to ultimately drive strategy, he said.
“Hospitals in small communities are often not just a healing engine but an economic engine,” Mr. Stevens said. “They’re often one of the larger employers in a community, at higher-than-average wages.
“So, everybody in the community who’s economically minded is interested in the health and well-being of the organization, and that often accrues to that local leader as the person who’s the face of us in that marketplace. We have to take that into account — all those key relationships.
“But the big idea is great operations that create access, durable clinical safety and quality, a pleasing experience, an engaging place for a workforce to be, and part of a larger team that’s looking at a bigger set of circumstances than just that one place.”
He added that efforts to redeploy leadership assets that can engage and create access amid these bigger industry circumstances are “neither casual nor unnecessary.”
“We have to find a way to do better,” Mr. Stevens said. “And better for me is not just financially, but it’s more access. [Adventist is rooted in] a faith-based tradition — that we want people to feel loved. But also, we’re trying to build something that we’d want for ourselves or our loved ones if we were sick, hurt or vulnerable and needed that.”
Keeping pace with change
Mr. Majzun reflected on how the COO role has evolved at his organization. He served as executive vice president and COO at Stanford Medicine Children’s Health before his promotion in February to president and COO.
When he first joined the health system, Mr. Majzun said his COO role was “all about getting the organization connected, getting it prioritized, getting it focused. That was probably my first couple years here. Then we started focusing more on culture and capacity and cost, and now, as we’re moving sort of into this new world, it’s about continuing performance. It’s about accountability, but it’s also about making sure that the pace of change inside our organization is reactive to the pace of change that we’re seeing externally.”
He noted that while COOs help implement the vision of their CEOs and boards, they are also “being asked to bring more of the outside world into the organization — whether that’s helping people to understand the pressures that we’re under and what that means for them, translating that into their day-to-day action, what they need to do differently.”
Ultimately, he views COOs as change makers who are unsatisfied with the status quo. This perspective is partially based on his experiences with his peers.
“The group that I interact with the most is the group from the Children’s Hospital Association,” Mr. Majzun said. “I would say half to three-quarters of that group is interested, longer term, in being CEOs, but there’s a quarter to a third — they really just want to make organizations run really, really well.”
With this perspective, he is aware that in recent years, COOs across industries have faced increased job insecurity, and some health systems have revamped the role or eliminated it entirely — a move he questions.
“Getting rid of the COO position for an organization basically means your CEO is going to have to take some of their eye off the external market and be focused a little bit more internally,” he said.
He also noted the importance of a COO in bringing other leaders together from across an organization to focus on a specific issue. In fact, he views the power of assembly as a COO’s greatest power.
“Generally, our vice presidents have agency within a silo — within a sphere — but I think we’re really expected to be working across the organizations in a broader way than perhaps before,” he said. “It may have been that COOs were very focused on making sure that the trains ran on time. I do think, increasingly, we’re being asked to start to figure out which directions the train should go in, which train should go faster, which train should go slower, which train shouldn’t go at all.”
These shifts are coming as COOs help navigate today’s industry challenges.
Amid workforce, financial, capacity and access challenges, he said he is particularly focused on cost and ensuring his organization is delivering value for patients.
“I’ve worked in other organizations which were much more focused on growth and accommodating growth,” Mr. Majzun said. “I do think the common thread that you’ll see throughout all the organizations is getting organizations focused and helping leadership teams to focus.
“As humans, we’re not always so great about saying, ‘No, we’re not going to spend time on this.’ But I spend some time with my direct reports reminding them that there are very important projects, wonderful things they could be doing, and those things are going to have to sit on the back burner for a little while.”
He said COOs are also expected to opine more on external financial circumstances and how that reality is influencing internal decisions.
“It’s always been important to have a great partnership with your CFO,” he said. “But increasingly, we’re being looked to to provide some of that financial leadership that historically we haven’t.”
Additionally, he said COOs must ensure their teams are focused on access and selectively expanding the businesses the organization wants to grow.
“If we look forward at some of the potential things coming out of D.C., and certainly some of the executive orders that we’ve seen, we will be challenged to be more efficient — both in our research enterprise and our clinical care enterprise and our education enterprise,” he said. “So, making sure the team stays very focused on the things that are going to yield the most benefit to our patients and our organization — I think that we turn that knob from maybe seven or eight up to 10 in terms of focus.”
Another area Mr. Majzun sees growing in importance for COOs and organizations is technology.
“The technologies that we didn’t know about two years ago are saving us thousands of hours right now — and very soon, hundreds of thousands of hours — as organizations,” he said. “So, things like AI, language models, thinking through how we’re applying machine learning and working with our vendors to ensure that they’re pushing those things forward — I think there’s a ton of excitement in that area, and that is not the role of the CIO. That, to me, is the role of the chief operating officer, to really push that throughout the organization.
“Each one of my executives has a digital transformation plan. I think that is one of the ways we’re going to continue to drive progress in the industry. And I feel like a kindergartner in the world right now, where I wish I was a graduate student with respect to technology — but I’m spending a lot of time learning about that and actually converting that into action inside our organization.”
