Hospital and health system CEOs are expected to balance growth, access, finances and operations. In 2026, they must also weigh new technology investments, including AI.
As AI adoption accelerates, the relationship between CEOs and CIOs has never mattered more. How leaders align — or fail to — on technology strategy increasingly determines whether an organization moves forward with confidence or stumbles into costly, avoidable risk. Earlier this year, CMIOs told Becker’s that AI is moving faster than governance structures, flagging uncontrolled adoption as one of the biggest IT risks facing health systems.
How are CEOs collaborating with CIOs on AI strategy and decision-making? And when is it a CIO’s responsibility to weigh in — or push back?
One of the greatest mistakes organizations make is viewing the CEO-CIO relationship as a technology partnership, Michael Archuleta, CIO of Mt. San Rafael Hospital in Trinidad, Colo., told Becker’s.
“It’s not. It’s a transformation partnership,” he said. “A CEO is responsible for the future of the organization. A CIO is responsible for helping the organization see that future before it arrives.”
That framing carries real implications. The most effective CIOs are not evaluating servers, software or AI tools, Mr. Archuleta said.
“They’re evaluating how technology decisions made today will reshape workforce models, patient expectations, financial performance and clinical operations five years from now,” he said. “That’s where a CIO has a unique responsibility to challenge assumptions and occasionally create discomfort in the boardroom.”
That means knowing when to pump the brakes.
“There have been moments where I’ve advocated aggressively for innovation, and there have been moments where I’ve advised caution because the foundation wasn’t ready,” Mr. Archuleta said. “Leadership is understanding the difference.”
Richard Tugman, president and CEO of Lynchburg, Va.-based Centra, said he recently hired a new CIO and changed the title to include “digital.” A strong CDIO brings a perspective a CEO can sometimes miss, he said, ensuring technology decisions are grounded in interoperability, cybersecurity, workflow realities and measurable value for patients and caregivers.
“In my opinion, a good CDIO has the confidence to challenge the CEO’s thinking, particularly when enthusiasm for a new technology, including AI, exceeds the organization’s readiness, evidence of benefit or simply the feeling for the need to ‘jump on the bandwagon,'” Mr. Tugman told Becker’s.
What CEOs can miss
The stakes of that challenge are high. In an environment where health systems are fielding pitches for AI tools across multiple departments, the gap between a promising demo and a safe, sustainable implementation can be significant, often falling to the CIO to make that gap visible.
A CEO can also overlook the unseen risk sitting underneath a technology decision, Darrell Bodnar, CIO of Berlin, N.H.-based North Country Healthcare, told Becker’s.
“A solution may look good strategically or financially, but the CIO is often in the best position to see what it will actually take to make it work safely and effectively,” Mr. Bodnar said.
That includes the support model, workflow impact, integration, interoperability, cybersecurity, data governance, vendor dependencies and third-party risk. It increasingly involves understanding where data is going, who is supporting the system, whether offshore or international partners are involved, and what exposure that creates.
“Technology is not just about systems anymore. It touches patient care, compliance, revenue cycle, operations and trust,” Mr. Bodnar said. “It is the CIO’s responsibility to weigh in when those risks are not fully visible to the rest of the leadership team. That does not mean slowing down innovation. It means making sure we understand what we are really saying yes to.”
Weighing priorities
Even when the CEO-CIO relationship is strong, technology investments do not exist in a vacuum. They compete with staffing, facilities, access and patient care, and the case for any given tool has to hold up against all of it.
“When weighing technology investments, I believe they must compete alongside every other strategic priority and demonstrate how they advance our mission, improve care, support our workforce, and create long-term sustainability,” Mr. Tugman said. “The CEO and CDIO partnership is most effective when it combines strategic ambition with disciplined execution.”
While there are a lot of ideas in healthcare promising shiny new features, a CEO’s responsibility is to stay grounded in what matters most: making health better, Tina Freese Decker, CEO of Corewell Health, dually headquartered in Grand Rapids and Southfield, Mich., told Becker’s.
“Our ‘rules of the road’ principles are a framework to evaluate technology investments, starting with being clear about the problem we are trying to solve,” Ms. Freese Decker said. “Strong, clinically and operationally led technology governance helps us prioritize solutions that support patient care, strengthen our teams and reflect responsible financial stewardship.”
The throughline across leaders: speed is not the goal. Alignment is.
“The goal is not to move fast or slow,” he said. “The goal is to move deliberately, choose the right use cases, put guardrails in place and make sure AI is enabling the work rather than creating new risk.”
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