The co-CEO model at health systems — once a recognized option for boards navigating mergers, retirements or the complexity of running a large clinical enterprise — is becoming less common.
That is the view from the executive search firms advising health system boards on leadership structure. Jena Abernathy, executive search specialist and sector leader for healthcare board and CEO services at Korn Ferry, told Becker’s that boards have historically been drawn to co-CEO arrangements for their promise of complementary strengths and unified leadership, particularly during periods of organizational change.
While the concept often sounds appealing in theory, she said, sustaining it has proved difficult.
“Healthcare organizations are incredibly complex, and ultimately there are moments when you need clarity around who is making the final decision and who is accountable for the outcome,” Ms. Abernathy said. “Most boards today are looking for that clear line of accountability while still benefiting from strong partnership and collaboration across the leadership team.”
The reasons boards were drawn to co-CEO structures in the first place remain valid, Ms. Abernathy said. What has changed is that many organizations have found other ways to achieve that balance — dyad partnerships, physician-executive models and highly collaborative executive teams — that provide the benefits of shared leadership while maintaining clear accountability.
Melissa Fitzpatrick, MSN, RN, president of Kirby Bates Associates, told Becker’s her firm is not seeing co-CEO appointments very often in the current market. Some arrangements were designed to support a merger or leadership transition and have since run their course, said Ms. Fitzpatrick, who has experience as both a chief nurse executive and a hospital board member.
“What we are currently seeing is growing interest in triad leadership models,” she said. “Executive triads bring administrative, physician, and nursing executives together to balance clinical and business priorities. Triads have one CEO with clear accountability and still have a strong, shared approach to leadership.”
Where co-leadership is working
Against that backdrop, two health systems have maintained co-leadership structures and credit them with significant organizational gains. Both point to the same core requirements: complementary skill sets, trust, clear division of responsibility and disciplined communication.
Camden, N.J.-based Cooper Norcross Health has operated under a co-CEO structure since 2018, when Kevin O’Dowd and Anthony Mazzarelli, MD, were named co-presidents by the board. The two had worked together on the senior executive team before that appointment. When the previous CEO retired in 2019, the board added the co-CEO title.
The pairing was built around different professional backgrounds: Dr. Mazzarelli is a practicing emergency medicine physician with administrative experience, and Mr. O’Dowd is a lawyer with significant healthcare, governmental and administrative experience.
“Given our differing skill sets, the division of responsibilities was easy,” Dr. Mazzarelli told Becker’s. He provides oversight of clinical, ambulatory and health facilities operations, while Mr. O’Dowd oversees the business, legal and administrative departments. “Our co-CEO model is based upon trust, collaboration, and speaking with one voice. The team knows that if you speak to one of us or we provide you with a decision, we have discussed the subject and we’re in agreement.”
Since the two took on co-leadership roles, Cooper’s team member engagement has climbed from the 32nd to the 73rd percentile nationally. Cash and investments have grown from $500 million to $1.7 billion, and the health system now holds A+ credit ratings from both S&P Global and Fitch Ratings. Total patient visits grew 21% in 2025 over the prior year.
The structure was tested most severely during the COVID-19 pandemic, when critical decisions had to be made nearly every hour under high stress and with competing views on life-and-death matters. Mr. O’Dowd told Becker’s working through that period gave both leaders confidence in the model.
“Being a sole CEO can be lonely and difficult,” he said. “We have the benefit of leaning on each other and during challenging times this is very helpful.”
For Mr. O’Dowd, the model’s sustainability depends on a set of requirements: equal partnership with both leaders setting aside ego, board commitment, trust, assumed good intent, clear roles and decision rights, and disciplined daily communication. When one or more of those elements is absent, he said, systems probably move away from the structure.
“You need to speak several times a day and share daily issues,” he said. “Then you must agree on the message to your teams. There can be no difference in the message, you must be disciplined and consistent.”
UK HealthCare’s co-EVP model
Lexington, Ky.-based UK HealthCare adopted a shared leadership model in 2023, pairing Eric Monday, PhD, executive vice president for finance and administration and co-executive vice president for health affairs, with Robert DiPaola, MD, provost and co-executive vice president for health affairs. The structure grew out of the system’s expansion in scale and complexity over two decades and reflects UK HealthCare’s dual identity as a health system and a component of the University of Kentucky.
Dr. Monday told Becker’s the model is not about dividing the organization in half or having two people do the same job, but about connecting expertise across an integrated university and academic health system.
“The complexity of healthcare today requires us to bring clinical, academic and institutional perspectives together, rather than addressing them independently,” Dr. Monday said.
Dr. DiPaola’s role as provost extends across education, research and the university’s colleges, while Dr. Monday connects the health system to the broader university’s finance and administrative infrastructure. Two leadership committees formalize that division. The executive clinical effectiveness leadership committee, led by Dr. DiPaola, oversees clinical activity, integrated service lines, and the talent and expertise that differentiates the academic health system. The healthcare infrastructure team, led by Dr. Monday, focuses on facilities, technology, growth strategy and institutional capabilities.
“The goal isn’t shared ownership of everything,” Dr. DiPaola told Becker’s. “It’s clear accountability and a shared responsibility for the success of the enterprise and our mission to advance Kentucky.”
Dr. DiPaola described the expansion of Chandler Medical Center — one of the largest projects in the history of the UK campus — as an example of how the model functions in practice. Clinical and academic leaders address the clinical need, expertise, talent and academic dimensions of an expansion decision, while Dr. Monday’s team considers the facilities, technology, operational capabilities and capital required.
“Those aren’t sequential conversations,” he said. “What we build is driven by what Kentucky needs, so it is critical that those decisions are made together.”
Dr. Monday said the model’s success also depends on the strength of the leadership teams surrounding the two executives and the partners they work with across the university and Kentucky.
“We rely on leaders with deep expertise across the clinical, academic and institutional enterprise, and empower those leaders to lead within a common strategy,” he said.
He framed the structure as right for UK HealthCare specifically, not as a universal prescription.
“We don’t believe there is one leadership model that is right for every health system,” Dr. Monday said. “Organizations have different needs, cultures and strategies, and their leadership structures should reflect those realities.”
Ms. Abernathy drew a similar conclusion, noting that the success of a co-CEO model has less to do with the organizational chart and more to do with the people involved.
“For it to work, there has to be tremendous trust, mutual respect, aligned values, and a shared commitment to the mission and vision,” she said. “When those ingredients are present, the model can be very effective. When they’re not, the challenges can outweigh the benefits fairly quickly.”
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