Hospital and health system CEOs are under heightened pressure in today’s industry environment to justify capital spending.
Policy volatility around Medicaid and reimbursement, tighter margins and a wait-and-see approach to mergers and acquisitions have pushed many leaders toward stricter ROI vetting before dollars move. Yet in conversations with Becker’s, CEOs across the country describe a different calculus for the investments they consider most important: the ones where the payoff cannot be modeled in a spreadsheet before the check is written.
Ten health system and hospital CEOs told Becker’s about the strategic investments they made — or are making now — without waiting for the financial case to fully close.
Their answers cluster around a few familiar tensions playing out across the industry. Several leaders described clinical and operational investments — from clinical AI to staff training — where the return shows up first in clinician time, culture or patient experience rather than a clean revenue line. Others pointed to workforce investment as a retention and recruitment strategy in its own right, not simply a cost to manage.
The following CEOs responded to the question: “What is one strategic investment your organization is making today that you believe most systems still underestimate — and what convinced you it was worth prioritizing before the financial return was fully proven?”
Editor’s note: Responses were lightly edited for clarity and length.
Marc Augsburger, BSN. President and CEO of Edgerton (Wis.) Hospital and Health Services: We are really putting a lot of time and energy into the patient experience. While the full return in investment are softer dollars, we believe the putting the customer first with live phone answering, warm handoffs, a meticulous 3-acre healing garden and practices such as taking patients/families where they need to go in our facility goes a long ways in making our customers happy which in turn leads to return visits. We receive quite a few kudos both in person and via our patient satisfaction surveys on how nice it is to visit our facility.
Michelle Conger. CEO of OSF HealthCare (Peoria, Ill.): When I think about strategic investments, I think about our investment in innovation. It is hard to define the ROI completely up front when you don’t know the exact outcome. At OSF HealthCare, we have found that the investment in innovation has set us up to build the healthcare system of the future.
We built a hospital-at-home program, for example, with uncertain long-term funding. We can now see the ROI in many ways; increased patient access, patient quality and patient satisfaction that will enable us to create a long-term new care model. This innovation is an investment in new technology and capabilities that probably would not meet a traditional hurdle rate for investment.
Stephanie Conners, BSN, RN. President and CEO of BayCare Health System (Clearwater, Fla.): One investment I believe health systems still underestimate is investing in their workforce as a strategic asset rather than viewing labor primarily as a cost. At BayCare, we’ve intentionally reframed the traditional healthcare mindset of “no margin, no mission” to a philosophy centered on great people, great outcomes. That belief has guided our investments in compensation, benefits, professional development and team member support, because we know that when we invest in our people and give them the runway to do their best work, extraordinary things happen.
What convinced us was the clear connection between engagement, retention, quality, safety and patient experience. Long before every financial return could be quantified, we could see that when team members feel valued, empowered and supported, patients receive better care and organizations perform better. Today, our philosophy is simple: Great people drive great outcomes. By investing in our workforce and creating an environment where they can thrive, we’re strengthening our ability to deliver exceptional care and fulfill our mission for years to come.
Robert Corona, DO. CEO of Upstate University Hospital (Syracuse, N.Y.): We serve a large geographic area that includes urban areas and very rural areas. We are creating many ambulatory sites to increase access, but this has created a logistics issue which I think can be underestimated.
We have invested in use of drones and robotics creating an autonomous healthcare logistics team to address the distributed locations. This has increased efficiencies and reduced costs. We have been very successful in medication delivery from our retail pharmacy locations and are opening a remote consolidated pathology institute that has a “drone bay” to receive specimens. We also have an expanding robot service in our hospitals and intend to do the same in the new pathology institute.
J. Scott Graham. CEO of Three Rivers Hospital (Brewster, Wash.): We decided to invest in staff training around quality and safety management. We worked with the Virginia Mason Institute and spent a year training with them, both at their facility and onsite at ours. The focus was on creating a grassroots movement within our organization that fostered finding solutions to help our staff remove “rocks in their shoes” (barriers to being able to do their best work). It has been amazing to see the culture change towards a positive, innovative and quality-focused mindset that has improved our processes, our patient care and our energy in a time where people feel burned out and discouraged. Our staff and our leaders are working together, shoulder to shoulder, to solve some of the most entrenched problems successfully and I feel that it has totally been worth every penny we invested to make this happen.
Alan Kaplan, MD. CEO of UW Health (Madison, Wis.): One strategic investment UW Health has made is building one of the nation’s most comprehensive healthcare apprenticeship programs, including apprenticeships for medical assistants, nursing assistants, registered nurses, surgical technologists, MRI technologists, pharmacy technicians, respiratory therapists and other key clinical roles. Through these programs, UW Health pays for participants’ tuition, books and required education while also providing hands-on clinical training, wages and employee benefits, removing many of the traditional barriers to entering healthcare careers. The investment was driven by a belief that growing our own workforce would create sustainable talent pipelines and strengthen patient care long-term. We’re seeing incredible rates of success with these programs, with almost 87% of participants completing programs and 80% retention post-graduation. Today, the program has trained more than 1,000 apprentices across multiple professions, validating that investing in people can be one of the most impactful workforce strategies a health system can make.
Rex McKinney. President and CEO of Decatur County Memorial Hospital (Greensburg, Ind.): One of the most underestimated investments in healthcare is genuinely listening to and engaging the community we serve. At Decatur County Memorial Hospital, we view community engagement as more than outreach or occasional activity. If we are going to be a gateway to health and wellness for our community, we must understand what our community needs, what matters to them and listen when they communicate opportunities for us to improve. Staying close to those we serve shapes not only the services we provide, but the patient experience we create, allowing us to continually evolve and remain the healthcare partner they need us to be. Each year our team commits hundreds of hours volunteering in our communities, providing several educational opportunities, collaborating with other community resources and hosting multiple events promoting wellness.
R. Lawrence Moss, MD. President and CEO of Nemours Children’s Health (Jacksonville, Fla.): At Nemours Children’s Health we embrace the fact that medical care is an important but small part of creating health for populations of children. We are proud to be investing deeply in kindergarten readiness not only for our patients but for every child who lives in our service area. This educational achievement is powerfully linked to a significantly lower incidence of chronic disease, greater lifetime earnings, and a more productive and lower stress life. Educational attainment of this kind predicts a longer life by more than a decade. That entire trajectory begins at age 5, when a child enters the kindergarten classroom, either healthy and ready to learn or already behind. If we want a well-prepared workforce, a stronger economy, and lower health care costs, getting children academically, physically, socially, and emotionally ready for kindergarten will have an impact far greater than any other investment we could make.
Arturo Polizzi. President and CEO of ProMedica (Toledo, Ohio): One of the most important investments ProMedica is making is in clinical AI. We prioritized it because we saw its potential to help address one of healthcare’s biggest challenges: giving physicians and nurses more time to focus on patients and less time on administrative work. While the financial return is still evolving, we were convinced it was worth pursuing because improving the day-to-day experience of our clinicians supports retention, strengthens recruitment, and helps us build a more sustainable workforce. In the long run, that positions us to deliver better care and meet the growing needs of the communities we serve.
Brian Sponseller, MD. CEO of Carolina Pines Regional Medical Center (Hartsville, S.C.): We often underestimate the importance of investing in the next generation of healthcare. I know for us, it’s not just about recruiting for the needs we have today — it’s about intentionally building the pipeline we’ll need years from now. That’s why we’re investing in our residency program, building strong partnerships with local nursing schools, and supporting students through scholarships and other opportunities that help them train and begin their careers close to home.
Of course, you don’t see immediate return with stuff like this — it’s more of a long-game move. But we’re already seeing the impact of these investments today, and that impact will only continue to grow. We believe that when you invest in the future of healthcare, you’re investing in the future of your community, so it’s easily worth it.
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