As health systems cut management layers and restructure their C-suites, executives are increasingly treating leadership vacancies not as positions to fill but as questions to answer: What work still needs to be done, and who should own it?
Those questions are shaping how leaders across systems think about their organizations through 2031, a period when financial pressure, technology adoption and strategic reorientation are converging.
Health systems are also redesigning their organizational infrastructure for the decade ahead, with leaders at Detroit-based Henry Ford Health, Houston Methodist and Cleveland-based University Hospitals describing structures built around faster decision-making, AI-enabled efficiency and clearer accountability. Three other executives shared with Becker’s how they are thinking about specific leadership layers and what guides their decisions when a role comes open.
Megan Brosious, executive vice president and COO of Danville, Pa.-based Geisinger, said financial pressure and workforce shortages are shaping her thinking about organizational structure, with technology playing a central role in how the system responds.
“We will likely see a flattening of leadership structures so we can invest the most in our front-line workers,” Ms. Brosious said. “Financial pressures mean we must think differently about how we work, and technology will be critical in how we manage workforce shortages.”
Ms. Brosious described a similar approach to vacancies, treating departures as an opportunity to reassess rather than simply replace.
“When a leader leaves today, we determine if our structures are serving us well and leverage the opportunity to determine if we can work differently, develop existing talent to maintain operations and performance or if we need to explore other options,” she said.
Jeff Sandene, president and CEO of Charleston, W.Va.-based Vandalia Health, named a different layer and expects it to grow rather than shrink. As the system works toward deeper integration and a full transition to Epic, physician leadership has become a strategic priority.
“I expect the physician leadership layer to change and grow the most over the next five years,” Mr. Sandene said. “As we transition to Epic and continue building a more integrated health system, physician leaders will play an increasingly important role in standardizing care, reducing unwarranted clinical variation, improving quality and outcomes, and strengthening the connection between clinical and operational decisions. Developing physician leaders will be essential to translating better data and technology into better care for patients.”
Mr. Sandene applied the same forward-looking logic to individual vacancies.
“We do not automatically backfill a leadership position,” he said. “We first look at whether the work and responsibilities are still needed in the same way, whether they can be consolidated across the system, and whether the role should be redesigned to better support our strategic priorities. As Vandalia Health continues to integrate, we want the right leadership structure for the future, not simply the structure we have had in the past.”
Florence Chang, president of Tacoma, Wash.-based MultiCare Health System, described a more fundamental shift, one that prompted a reorganization of executive leadership in 2026. MultiCare restructured around three platforms — Care Delivery, Care Financing and Support Services — as the system grew from four hospitals to 18, with five more joining Nov. 1.
“Our focus has been on how we scale the organization in support of our strategic objectives and ensure we have clear accountability without overlapping responsibilities,” Ms. Chang said. “We want the structure to be scalable and durable.”
That standard extends to how MultiCare handles individual vacancies.
“We try not to begin with the assumption that every vacancy should be replaced,” Ms. Chang said. “A leadership departure creates an opportunity to ask: What work still needs to be done? What has changed? Where should decisions be made? And what structure will best serve our patients, employees and mission going forward?”
The question, she said, reframes the exercise entirely.
“The question is not, ‘How do we replace the person who left?’” she said. “The question is, ‘What leadership structure will best serve MultiCare’s future?’”
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