Few leaders feel the effects of organizational structure more directly than those responsible for clinical care. CMOs and CNOs describe how their systems need to be built to keep patients safe, teams engaged and operations sustainable.
Becker’s asked chief medical officers and chief nursing officers from hospitals, health systems and academic medical centers across the U.S. what their organization’s structure needs to look like to achieve sustained success.
Every executive featured in this article will speak on panels on the CMO + CNO Summit track at Becker’s 14th Annual CEO + CFO Roundtable, taking place November 2-5, 2026, in Chicago. Attendees will have the opportunity to hear these and other health system leaders discuss the challenges shaping strategy for the year ahead, from workforce retention and AI integration to OR operations.
Registration is open now for the 14th Annual CEO + CFO Roundtable. Register here to secure your spot and join the conversation with the executives featured below.
If you would like to join as a speaker or a reviewer, please contact Mariah Muhammad at mmuhammad@beckershealthcare.com or agendateam@beckershealthcare.com.
For more information on sponsorship opportunities, please contact Jessica Cole at jcole@beckershealthcare.com.
Question: How will your organizational structure evolve for sustained success through 2030?
Zafar Jamkhana, MD. Vice President of Medical Affairs and Chief Medical Officer at SSM Health St. Mary’s Hospital – St. Louis and SSM Health Saint Louis University Hospital (St. Louis): Through 2030, the pace of change and the capital it requires mean the industry will have to make hard decisions about its priorities and their sequence. At SSM Health, our diversification and financial strength mean we are better situated than many. Patient acuity keeps rising, and we are likely to see much sicker patients in the communities we serve as families postpone care because they are uninsured or underinsured. As an industry, we have done a good job managing chronic conditions, which is why the patients who now come in for care often carry several of them. The approaching cuts to Medicaid will make this more difficult for all hospitals and health systems.
To be ready, we need to be a truly integrated network that connects patients and caregivers with the specialists they need and provides the right care at the right time in a location that’s convenient for them. At SSM Health, we are fortunate to already have one instance of the electronic medical record, and we are on pace to go live on one of the most advanced EHR platforms next March. Yet, like many health systems, our first priority must be a deeper bench in every role, from physicians and advanced practice providers to nurses and technologists, because it has the longest lead time. That means finding a shorter path into the workforce at the same standard, with specialization starting further upstream and AI augmenting our teams so we reach the right skill mix faster. At the same time, our clinical teams are organizing around the strategy with clear decision rights, and they are already making significant inroads.
Arshad K. Rahim, MD. Chief Medical Officer and Senior Vice President and CIN, Population Health, Mount Sinai Health System (New York City): In my role in population health and through collaboration across our ambulatory and at-home teams, we are looking to further connect with patients outside of the traditional care delivery setting in their day-to-day, at home and at work, to help prevent disease and drive better health and longevity outcomes. This will remain centered on the clinician-patient/family relationship but will be technology enabled to help scale impact and drive cost-effectiveness in care delivery.
Stephen B. Williams, MD. Chief Medical Officer of UTMB Clear Lake (Webster): Our structure has to move decision-making closer to the bedside. Over the next several years, I expect to see more physician-administrator dyad leadership at the service-line and campus level, with clinical and financial accountability sitting with the same team instead of being split across silos. Quality, safety and value will be built into how those teams operate every day in real time dashboards, with shared metrics, rather than housed in separate departments that report up after the fact. As systems grow across multiple campuses like ours within UTMB and specific to Clear Lake campus where I’m CMO, our network hospitals need enough local authority to act quickly while staying aligned with system-wide standards. Decentralization without integration leads to fragmentation. Data and AI will flatten some layers by putting real-time performance information directly in front of frontline leaders, and we will have to deliberately develop physicians as leaders, because structure only works when there are people prepared to lead within it.
Sunil Patel, MD. Chief Medical Officer of Prime Healthcare (Ontario, Calif.): By 2030, I think the traditional C-suite structure will look very different. Many of our current leadership roles were designed around clearly defined functional silos such as operations, finance, clinical care, IT and strategy. That structure is increasingly too narrow for the problems healthcare organizations need to solve.
AI is a good example. AI cannot simply sit within the CIO or CMIO organization. As AI and increasingly agentic tools become embedded into clinical care, revenue cycle, access, workforce management and operations, they will require shared ownership across clinical, operational, financial and technology leadership.
That means our leadership structure needs to become more cross-functional and more nimble. We will still need deep functional expertise, but leaders will increasingly be accountable for outcomes that cross traditional departmental boundaries.
The organizations that succeed through 2030 will not necessarily be the ones that add the most executive positions. They will be the ones that break down silos, create clear enterprise accountability and build leadership structures capable of adapting as quickly as technology and healthcare delivery are changing.
Sriram Vissa, MD. Vice President of Medical Affairs and Chief Medical Officer at SSM Health DePaul Hospital (St. Louis): As I look toward 2030, I believe healthcare organizations will face increasing financial pressure from declining reimbursement and policy changes, including the potential impact of the One Big Beautiful Bill Act. With fewer resources, health systems will need to shift from delivering more care to improving health outcomes while providing higher-value care. Success will depend on reducing unwarranted variation, improving quality, optimizing supply chain and operational performance, and embracing innovation to drive greater efficiency. We will also need to expand beyond traditional office-based and inpatient care through ambulatory, virtual, home-based, and other care models that better meet patients where they are. AI will undoubtedly be part of the solution, but its value will come from how responsibly we use it to help clinicians and leaders make better decisions, reduce inefficiencies, and improve outcomes. At SSM Health, this will require even closer collaboration among clinicians, operational leaders, data scientists, and digital health teams. Medical affairs has a unique role in connecting clinical evidence, quality improvement, innovation, and physician leadership to help guide these changes. Ultimately, the organizations that thrive will be those that can adapt quickly, continuously improve, and remain focused on delivering the best possible outcomes at the lowest sustainable cost.
Kyle W. Trecartin, MD. Chief Medical Officer of Beth Israel Deaconess Hospital–Plymouth (Mass.): As Beth Israel Lahey Health looks toward 2030, I believe our organizational structure will continue to evolve from a collection of strong individual hospitals into a more integrated health system. That evolution is central to our strategic plan, which we call Blueprint 2030, and its vision for extraordinary, innovative, and seamless care that is closer to our patients and communities.
We have significant opportunities to build more systemwide approaches in areas such as quality and patient safety, creating greater consistency, accelerating shared learning, and spreading best practices more rapidly. At the same time, greater integration should be paired with greater frontline empowerment. Local leaders need the authority and accountability to identify problems and implement solutions that meet the needs of their patients and communities.
For me, sustained success through 2030 will depend on finding that balance: operating more effectively as one system while preserving the local leadership, relationships, and responsiveness that make our organizations strong.
Tracie Thigpen, MSN, RN. Chief Nursing Officer of CareSouth Carolina (Hartsville): I anticipate the entire organizational structure at CareSouth Carolina evolving over the next few years. The organization must strategically transform from one that is primarily focused on individual departments to one that is focused on patient populations receiving care through integrated teams. Accomplishing this transformation will require us to incorporate quality and technology into all aspects of care.
The nursing department will become a more strategic component of the organization, helping to drive care delivery and outcomes rather than functioning primarily in a support role. Leadership will also need to place greater emphasis on workforce development and retention rather than relying on short-term recruiting strategies. Ultimately, this evolution will require transformation throughout CareSouth Carolina, beginning with leadership and extending to every employee across the organization.
Julie Ishak, RN. Chief Nurse and Operations Executive of Michigan Medicine (Ann Arbor): Like many academic medical centers, Michigan Medicine’s organizational structure will need to continue evolving to meet the needs of our communities and remain relevant and successful. As we look toward 2030 and beyond, that means finding ways to simplify operations, reduce unnecessary complexity, and create a nimble organization that makes it easier for our teams to deliver the high-quality care we’re known for.
As we grow, we are continually focused on thinking and operating as one academic medical center and not as a collection of individual hospitals, departments, and locations. That means finding more ways to learn from one another, work together effectively, and build on our collective strengths while preserving what makes each part of our organization unique. Some of our current initiatives like One Epic are an important demonstration of how our shared systems, standardized workflows, and integrated teams can improve the experience for both patients and care providers while creating a scalable foundation for future growth.
We also believe success will depend on becoming even more consumer-centered, viewing care through the patient’s journey and removing unnecessary barriers to accessing the right care in the right place at the right time. Our statewide network, including affiliations and strategic partnerships across Michigan, reflects our commitment to bringing Michigan Medicine’s expertise closer to home while strengthening connections across the continuum of care.
Ultimately, our growth through 2030 must be intentional, sustainable, and deliver seamless, accessible care. Our goal isn’t simply to become larger, it’s to become more connected, more effective, and better positioned to deliver the quality, expertise, and innovation to more communities across Michigan and beyond.
Asa Oxner, MD. Vice President and Associate Chief Medical and Quality Officer of Ambulatory at Tampa General Hospital (Fla.): We are evolving from structures organized largely around the hospital to an enterprise model that manages performance across the full continuum of care. First, we are redesigning service-line governance so ambulatory leaders and measures sit alongside inpatient leaders and measures, bringing access, growth, quality, patient experience, utilization, and financial performance into the same accountability structure.
Second, we are expanding our quality domain model across the system, so inpatient and ambulatory priorities are managed through common governance, metrics, and escalation pathways rather than parallel structures.
Third, we are establishing enterprise care coordination governance with explicit executive accountability and cross-functional operating and technology workgroups to standardize roles, handoffs, workflows and performance measures across teams.
The “why” is straightforward: a large academic health system cannot solve capacity, throughput, quality, or affordability within hospital walls alone. Avoidable acute-care utilization, revisits, delayed follow-up, and inpatient work that could be delivered safely in lower-cost settings are all continuum problems. The “how” is to align decision rights, shared metrics, standardized workflows, and technology across inpatient, ambulatory, service-line, population health, and care-transition teams, creating one operating model that can move patients reliably to the right care setting, scale what works, and sustain performance through 2030.
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