When two senior executives retired at St. Cloud, Minn.-based CentraCare, the system did not fill either seat.
Rather than replace them directly, Chief Human Resources Officer Kim Egan and her team used the departures to reevaluate its C-suite structure. CentraCare implemented a broader leadership restructuring in July 2025, one aimed at improving integration, streamlining decision-making and enhancing collaboration systemwide. The net effect at the C-suite level: the size of the team stayed roughly the same.
For now, that picture holds more broadly. Health system leaders told Becker’s in December that C-suites would begin to shrink by 2030, driven by AI-driven efficiencies, tightening margins and the consolidation of roles — with new positions focused on data and transformation emerging alongside or in place of more traditional ones.
Across the executives who spoke with Becker’s in July, that shrinkage has not fully arrived — and for some systems, it may not come at all. What executives described instead is an evolution: roles redefined, structures reshaped and headcount held roughly steady as organizations position themselves for what comes next. Some systems have already slimmed down their C-suites in 2026 through combined and eliminated roles, while others have grown them. But the more common pattern, at least for now, is reconfiguration over reduction.
At CentraCare, the two retirement vacancies went unfilled. In their place, the system added a chief strategy and transformation officer, a role built to anchor long-term planning and help the organization navigate what Ms. Egan told Becker’s is an increasingly dynamic healthcare environment. The role has already proven valuable.
“The position has helped us navigate market changes, including new entrants to the market and evolving industry dynamics, while also advancing long-term strategic thinking and organizational planning,” Ms. Egan said.
Then came a second C-suite shift. When CentraCare’s chief physician officer chose to return to clinical practice, the departure became a redesign opportunity. The system redefined the role as chief clinical officer, a title Ms. Egan said better reflects the scope of the position and its mandate to build alignment across physician and advanced practice provider groups.
What Ms. Egan is watching for in that hire goes beyond filling a vacancy. The chief clinical officer role is meant to function as a connective layer across CentraCare’s clinical partner groups.
“The position is designed to strengthen alignment across our clinical partner groups, foster shared purpose, and support a unified approach to clinical leadership,” she said. “As we complete the search process, we look forward to building on the strong clinical foundation already in place and further enhancing collaboration across the organization.”
At Duarte, Calif.-based City of Hope, the C-suite has grown. CEO Robert Stone told Becker’s the additions over the past two years reflect the organization’s mission of improving lives of patients with cancer and other life-threatening illnesses.
“Over the past 24 months, we have welcomed new leaders to the C-suite, including a chief commercialization officer to accelerate the translation of scientific discoveries into new treatments and therapies and a chief AI officer to harness emerging technologies that benefit the 200,000 patients we serve across the nation each year,” Mr. Stone said. “Together, these and other leadership additions strengthen our ability to deliver breakthrough discoveries, exceptional care and better outcomes for the people who are at the center of everything we do: our patients.”
At Naples (Fla.) Comprehensive Health, President and CEO Paul Hiltz said the executive team has remained roughly consistent in size over the past 18 to 24 months. The system has been intentional about evolving roles and responsibilities to better align with strategy priorities, he told Becker’s.
“Rather than simply adding positions, we’ve focused on ensuring our leadership structure reflects the changing needs of healthcare and supports operational excellence across the organization,” he said.
The system has made several strategic adjustments to strengthen its leadership model, including establishing an Enterprise Management Program Office to sharpen accountability and coordination across key strategic work. Finance and operations were restructured to keep pace with continued growth. Patient experience and quality were integrated more closely. Human resources became a people and culture function, a shift Mr. Hiltz said has helped the system build a workforce for what’s ahead.
“These changes have strengthened alignment across the organization and improved our ability to execute on strategic priorities,” Mr. Hiltz said. “The EMPO has enhanced coordination and accountability for major initiatives, while the closer integration of patient experience and quality has created a more comprehensive, unified approach to delivering exceptional care.”
The people and culture reframing has shown early returns, he said.
“Overall, these leadership changes have resulted in stronger collaboration, faster decision-making and a more agile organization that is better positioned to deliver outstanding outcomes for our patients and the communities we serve.”
At Bellaire, Texas-based Harris Health, President and CEO Esmaeil Porsa, MD, approaches C-suite architecture by focusing on whether the right leaders are in place, not how many.
“Healthcare is constantly changing, and effective leadership requires the adaptability to meet new challenges while remaining grounded in our mission,” Dr. Porsa told Becker’s. “As such, we have been laser focused on our C-suite culture. We have invested heavily in time, effort and resources to ensure that our executive leaders fully embrace and are aligned with our system values. I believe this has been the crucial ingredient in a very stable, high-performing leadership team able not only to react to the unique demands we face as the only public safety-net healthcare system in Harris County with the highest rate and number of uninsured in the U.S., but also to develop and act on an audacious and future-leaning strategic plan.”
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
