Every healthcare organization has habits it has never questioned, whether that’s measuring success by volume instead of outcomes, assuming ambulatory care and health systems can’t coexist, or clinging to “this is how we’ve always done it.” The leaders willing to name those habits out loud are often the ones best positioned to change them.
Becker’s asked CEOs, presidents and executive directors across hospitals, health systems and specialty organizations one question: What’s one sacred cow at your organization that needs to go? Their answers, below, range from entrenched processes and hierarchy to the belief that healthcare has to be difficult to access in order to be high quality.
Editor’s note: Responses have been lightly edited for clarity and length.
Angela Hapke. CEO of Kamloops Surgical Centre (British Columbia): One sacred cow that needs to go is the assumption that talking about change is the same as creating it. Healthcare doesn’t suffer from a lack of ideas, it suffers from a lack of execution. Real innovation and momentum happen when organizations move from discussion to action, rather than defaulting to what has always been done.
Po Chou, PhD. CEO of Macon & Joan Brock Virginia Health Sciences, EVMS Medical Group at Old Dominion University (Norfolk, Va.): Every few years, there are market dynamics that change the way that we deliver healthcare. Whether it is the result of value-based, site-neutrality, technology/AI or anything else — one sacred cow that needs to go is the “same old, same old.” If we don’t change, progress and evolve as a healthcare organization, we will not be ready for the future that awaits us.
Ladi Kukoyi, MD. Executive Director and CEO of Birmingham (Ala.) VA Health Care System: “We’ve always done it this way”.
Scott Polenz. CEO of OakLeaf Surgical Hospital (Altoona, Wis.): The belief that “this is how we’ve always done it.” Healthcare has become incredibly complex — for patients and caregivers alike. As leaders, we need to continually challenge unnecessary processes, simplify how we work, and empower frontline teams to improve the experience for both patients and staff.
Laura Outlaw, BSN, RN. CEO of The Aviary Recovery Center (Eolia, Mo.): One sacred cow that needs to go is measuring success by activity rather than outcomes. Healthcare has historically rewarded volume, but patients, payers and communities are increasingly demanding proof that care is making a meaningful difference. In behavioral health, that means focusing on recovery, improved quality of life and sustained engagement in care. The future belongs to organizations that can demonstrate real outcomes and create lasting value for the people they serve.
John Reynolds. CEO of Bone and Joint Institute of Tennessee (Franklin, Tenn.): The sacred cow that needs to go is the belief that that ambulatory care and health systems are mutually exclusive.
From a leadership perspective, my role is to ensure our organization is building the relationships necessary to thrive in a changing environment. The question isn’t whether healthcare will change, it’s whether we’re shaping that change or responding after competitors have already moved first.
Craig Aasved. CEO of Shodair Children’s Hospital (Helena, Mont.): For decades, Shodair has been organized around volume — more admissions, more procedures, more visits. While Shodair must remain financially viable, the future is increasingly rewarding organizations that improve outcomes, prevent illness, coordinate care and keep people healthy whenever possible.
Letting go of that mindset means asking different questions:
- Are we improving the health of our community?
- Are patients and families experiencing coordinated, person-centered care?
- Are we reducing preventable hospitalizations?
- Are we investing enough in behavioral health, primary care and prevention?
Other sacred cows include:
- “We’ve always done it this way.” Long-standing processes should be regularly reexamined.
- Hierarchy over collaboration. The best ideas often come from frontline clinicians and staff, not just senior leaders.
- Treating behavioral health as separate from physical health. Integration is becoming increasingly important.
- Measuring activity instead of value. Being busy isn’t the same as making the greatest impact.
Kenneth Waller. Norwalk (Conn.) Community Health Center: The ideology that nonprofit safety-net providing organizations are mission driven only, and that healthcare executives should be focused on ensuring mission is met and not margins. Well, this would illustrate a dichotomy. If organizations cannot capture operation income, there will never be a mission to pursue.
Eric Doherty. CEO of My Pediatric Doctor (Atlanta): The biggest sacred cow that needs to disappear is the belief that healthcare has to be difficult to access in order to maintain quality.
For decades, the industry has accepted long wait times, fragmented care, complex scheduling and disconnected systems as unavoidable. They aren’t. Patients shouldn’t have to determine which type of provider to see, navigate multiple portals, repeat their medical history at every visit, or wait days or weeks for care that could often begin immediately. Technology now allows us to eliminate much of that friction while preserving — and in many cases improving — clinical quality.
As we build QC Healthcare, we’re intentionally challenging that assumption. Whether someone enters through My Pediatric Doctor, My Adult Doctor, or one of our specialty platforms, our focus is creating a simplified experience that combines rapid access, coordinated care, intelligent decision support and continuity across the patient’s healthcare journey. The future isn’t simply faster healthcare — it’s healthcare that is dramatically easier to use.
Rachel Patzer, PhD. President and CEO of Regenstrief Institute, Professor of Surgery at Regenstrief Foundation (Indianapolis): One sacred cow that needs to go is the notion that producing research alone is enough to change practice or lead to change. As a research institute, generating evidence remains fundamental to our mission, but today’s challenges require us to think beyond publications. That is why our researchers and teams go beyond the data and the models — we focus on evaluating real-world implementation of technologies, solutions and treatments. In addition to data and data quality, we have to focus equally on implementation, adoption and measurable impact in the health system. Success should be defined by the impact our research has on improving patient outcomes, informing policy decisions (institutionally, regionally and nationally), supporting clinicians and transforming healthcare delivery.
Jonathan Forte. CEO, Yellowstone City-County Health Officer, RiverStone Health: The one “sacred cow” I’d challenge is … the belief that every important decision needs to be vetted, coordinated, and managed through the traditional hierarchy before action can occur. Our sacred cow is the assumption that leadership’s job is to make most of the decisions.
To become a true Employer, Provider, and Partner of Choice, RiverStone Health we are working to shift from a culture where decisions are elevated upward to one where information flows upward and decisions are pushed downward, to the people closest to the patient, community, or operational problem.
The results we’ve seen are greater employee ownership and engagement, better responsiveness to patients and community needs, stronger leadership bench strength, and increased organizational agility during financial, workforce, and policy changes.
Our organizational philosophy focuses on psychological safety, high-performing teams, and the principle that culture enables strategy execution. If anyone wants to replicate this in their organization, I would frame the provocative question this way: “What decisions are we still making at the senior leadership level that competent managers, directors, or frontline teams should be making without us?”
It could be the most important barrier standing between your organization’s current success and its next stage of growth.
Ivan Mitchell. CEO, Great Plains Health: As a nonprofit community hospital, we are going to have to accept that we cannot continue to provide services that are needed, if we can’t figure out how to break even. This will be difficult for all of the nonprofit community hospitals.
Rachel Hersh, DrPH, BSN, RN. President and CEO, La Red Health Center: Business and waste! Moving isn’t movement, and I feel like healthcare has become addicted to activity instead of meaningful outcomes. We celebrate how hard everyone works instead of asking whether we’re actually making it easier for patients to get care and providers to see patients. If a process doesn’t improve quality, access, sustainability, or the patient experience, it deserves to be questioned, no matter how long we’ve been doing it. I feel the same about data (and I love data). We should measure with purpose. Every metric should answer a meaningful question, inform a decision, or improve care. If it doesn’t, we should ask why we’re collecting it.
Rajeev Singhai. Hospital CEO, Cancer Hospital: One “sacred cow” I believe healthcare organizations should challenge is the mindset that “this is how we’ve always done it.” Many hospitals continue to rely on manual processes, fragmented communication, and legacy workflows simply because they are familiar. While these practices may have worked in the past, they often create delays, increase costs, and affect both staff efficiency and patient experience. I believe every process should be open to review. If technology, data, or a redesigned workflow can improve quality, safety, efficiency, or patient satisfaction, we should be willing to change. Respecting what has worked historically is important, but continuous improvement should always take priority over tradition. My approach is to make decisions based on evidence, measurable outcomes, and the needs of patients and staff—not on habit.
Chris Ware. CEO, Russellville Hospital: One sacred cow that needs to go is the mindset that “this is the way we’ve always done it.” In healthcare, that mentality is one of the biggest barriers to improvement. Every process, workflow, and service line should be evaluated based on whether it improves patient care, supports our staff, and contributes to the financial health of the organization. That doesn’t mean abandoning tradition or what works. It means being willing to challenge long-held assumptions with data. If a process creates delays, unnecessary costs, or frustration for patients or employees, we should have the courage to change it — even if it’s been in place for years. As leaders, we have to create a culture where continuous improvement is expected, not feared. The healthcare landscape is changing too quickly for us to rely on yesterday’s solutions. Our responsibility is to adapt while staying true to our mission of providing exceptional care to our community.
Jodi Daly, PhD. President, CEO, Comprehensive Healthcare: The biggest sacred cow is this: The belief that we, our community based mental health organization, is primarily providers of behavioral health services.
That identity has served community mental health well for decades, but it is no longer enough.
The organizations that will thrive won’t define themselves by the therapy they provide, the psychiatry they deliver, or the number of billable visits they generate. Instead, they will define themselves by the health outcomes they help create across their communities.
The question shifts from: “How do we provide more behavioral health services?” to: “How do we improve the health of our communities through behavioral health?”
This means moving beyond the walls of the behavioral health clinic and embedding behavioral health into primary care, specialty care, hospitals, schools, employers, jails, homeless shelters and community organizations.
If behavioral health is becoming the foundational layer of healthcare, then community mental health organizations must evolve from being behavioral health providers to becoming community health transformation organizations.
That is the strategic shift. The future belongs to organizations that see behavioral health not as the destination, but as the catalyst for improving whole-person health.
Staci Holt. CEO, Graybill Medical Group: One sacred cow that needs to go is the mindset of “we’ve always done it this way.” Every process should be challenged based on whether it improves quality, patient experience, or value. Healthcare organizations that are willing to rethink legacy workflows will be better positioned to adapt to a rapidly changing environment.
Lawrence Antonnuci. CEO, Lee Health (Fort Myers, Fla.): One sacred cow that healthcare must continue to challenge is the belief that patients should adapt to our system rather than the system adapting to patients. For decades, healthcare has been organized around facilities, departments, schedules, reimbursements and processes. While those structures were built with good intentions, they do not always align with how people want to access care today. The organizations that succeed in the future will be those willing to redesign care around the patient experience—making care easier to access, easier to understand, and easier to navigate. That requires challenging long-standing assumptions, embracing innovation, and being willing to change practices that no longer serve our mission. At Lee Health, our responsibility is not to protect traditions; it’s to ensure that every decision advance access, quality, and the health of the communities we serve.
Beau McNeff. CEO, Weiser (Idaho) Memorial Hospital & Clinics: I don’t know if this is a sacred cow, or just a taboo, but we don’t talk about money well. Staff don’t like to ask for money from patients, patients get offended at times when their cost share is high, and as leaders it can feel unpleasant to focus on margin. The truth of the matter is that without the efforts to collect and receive funds, we won’t be able to provide the care we provide. That’s even more true in rural America where we are so heavily Medicaid and need the commercial business to make ends meet. I’ve been working with my teams for nearly a year to break down the barrier and get more comfortable talking about our finances and patient’s collections. We focus on the ‘why’ behind the need so people know we’re charging a fair price for the service in order to keep our doors open.
Rolland Bojo, MSN, RN. President and CEO, UHS Delaware Valley Hospital: We cannot do that here because we are a small hospital.
Maurice Ware. CEO, Kenneth Young Center: Which also leads us to the sacred cow we’re killing, working in silos. While most behavioral healthcare orgs have excelled at creating fantastic standalone programs over the years, they often operate in ways that feel disconnected to the client. Here at KYC, we’re shifting from a collection of services to a true continuum of care with every department collaborating around the client. It’s not about having a bunch of programs … it’s about making your programs act like one.
Joseph Hurley. CEO, AVORS Medical Group: The sacred cow that needs to go is the mindset of “we’ve always done it this way.” In healthcare, tradition often creates unnecessary complexity and administrative burden. Every workflow should be challenged to answer one question: Does this improve patient care or the patient experience? If the answer is no, it’s time to redesign it. As CEO of AVORS Medical Group, I believe continuous improvement and responsible innovation are essential to building a more efficient, patient-centered healthcare system.
James Holland. President & CEO, Johns Hopkins Health Plans (Baltimore): The belief that broad prior authorization is our primary leverage for medical cost control. Health plans have historically treated prior auth as a universal blanket, but for routine, low-variability care it can create more administrative friction and delay than the cost it prevents. The sacred cow that needs to go is the idea that more utilization hoops equal better care management. Transitioning away from blunt-force pre-approvals toward automated real-time authorizations, physician gold-carding, and predictive analytics allows payers to maintain necessary clinical oversight, eliminate friction for high-performing providers, and speed up time-to-care for our members.
Paul Camangian. President and CEO, Our Lady of Lourdes Hospital (Lafayette, La.): The belief that healthcare must choose between quality, affordability, and compassion. Patients deserve all three. At Our Lady of Lourdes Hospital – Manila, we’re challenging ourselves to simplify processes, remove unnecessary bureaucracy, and use technology to improve efficiency so our people can spend more time caring for patients. Better care doesn’t always require bigger budgets; often it requires better execution.
Healthcare has spent decades optimizing systems that were built for a different generation of patients, a different workforce, and a different economic reality. Yet many organizations continue to defend outdated processes simply because they have become culturally comfortable.
Tiffany Means, DNP, RN. CEO, Eureka Springs (Ark.) Hospital: At Eureka Springs Hospital, we challenge ourselves to ask a simple question: If we were designing healthcare from scratch today, would we build it this way?
More often than not, the answer is no.
Innovation is not about adding new technology onto old thinking. It’s about having the courage to reimagine care delivery entirely. That means questioning long-standing assumptions about access, staffing models, service lines, patient flow, reimbursement strategies, and even what a hospital should be.
The greatest threat to healthcare organizations today is not disruption. It is complacency.
As leaders, our responsibility is not to preserve systems that no longer serve the future. Our responsibility is to create systems that do. Sometimes that means honoring tradition. Sometimes it means retiring it.
The organizations that will define the next decade of healthcare will be those willing to challenge yesterday’s assumptions in order to better serve tomorrow’s patients.
The idea that healthcare must continue operating through fragmented, manual processes simply because “that is how it has always been done.” We need to simplify workflows, automate repetitive administrative work and allow physicians and staff to focus more of their time on patients.
Cliff Robertson, MD. President and CEO, St. Francis Health System (Tulsa, Okla.): Fee for service payment and broad network insurance plans must fall by the wayside. We need individuals to pick a health care “team” that they can work with over time to improve their health. If we can develop longitudinal relationships with our community members, we can make investments that improve health over the long term. Without this fundamental shift, health care will remain transactional and disconnected.
Robert Vissers, MD. President and CEO, Boulder (Colo.) Community Health: Healthcare doesn’t need another arms race measured in buildings and beds. The patient, not the hospital, should be at the center of the healthcare universe. The future is about putting the right care in the right place, not simply building more of it.
Joseph Woodin, President and CEO, Copley Hospital (Morrisville, Vt.): The silos of competency driven by degrees and certifications will become less relevant as we struggle to produce results and tamp down expenses. More and different APPs will emerge to fill the gaps; like a Certified Registered Nursing Radiologist, of a General Surgeon. I made those up – but think them to be viable. Healthcare needs to perform adding more value with less academia driven, expensive hires. Primary Care physicians will go “back to the future” and perform more minor procedures in the office setting to boost their revenue (appropriately), lauded by insurance companies and those self-insured.
Ara Baghdasarian, MD. CEO, Southern California Medical Center (Van Nuys, Calif.): Manual workflows that remain simply because “that’s how we’ve always done it.” Healthcare can no longer afford processes that add work without improving access, quality, or the patient experience.
Esmaeil Porsa. President and CEO, Harris Health (Bellaire, Texas): The one sacred cow that is increasingly out of alignment with our strategic direction is the belief that every department, hospital, clinic, or service line should be allowed to operate differently because “that’s how we’ve always done it.” At Harris Health, we bring this notion to front of mind under the “One Harris Health” slogan. This entails minimizing variation, creating consistent policies and procedures, integrating our hospitals and ambulatory care platforms, and leveraging technology and standardization to improve value and outcomes. This is how the sacred cow sounds like:
- “Our clinic is different.”
- “Our hospital is different.”
- “We’ve always owned that process.”
- “Every department needs its own workflow.”
This is what we want to replace the sacred cow with:
- Standardize whenever variation does not add value.
- Share best practices across hospitals and clinics.
- Use common clinical pathways and operating processes.
- Organize around the patient and community rather than organizational boundaries.
The sacred cow that needs to go is unnecessary variation. In a future defined by value, quality, access, and affordability, we cannot afford to operate as a collection of excellent individual departments. We must operate as one system of care, as One Harris Health.
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