Ascension came out of the COVID-19 pandemic losing more than $3 billion a year. The St. Louis-based health system had 140 hospitals across 16 markets, geographically dispersed and primed for transformation. The leadership team realized they need to go beyond a better growth plan to redesign the operating model.
“What got us here won’t get us there,” Amber Sims, executive vice president and chief strategy and growth officer at Ascension, said during a panel discussion at Becker’s Healthcare’s CEO + CFO Roundtable. “We were losing more than $3 billion a year. Our portfolio was rather large and not necessarily strategic.”
What Ascension built in response was a three-component operating model led by CEO Eduardo Conrado with growth, owned by Ms. Sims; optimization and efficiency, owned by Sally Deitch, executive vice president of operations infrastructure; and rate — managed care and revenue cycle — owned by the CFO Saurabh Tripathi. Each component is designed to depend on the others.
“We can’t grow the business if we don’t have optimization, efficiency, access and throughput,” Ms. Sims said.
The model also required a structural decision about how strategy and operations would work together. The practical expression of that decision is a working relationship between Ms. Sims and Ms. Deitch that both describe as deliberately contentious. Neither operates in a fixed lane. Ms. Deitch, a registered nurse with 36 years of clinical experience who worked her way from staff nurse to hospital CEO before joining Ascension five years ago, stays close to strategy. Ms. Sims, who built her career in operations and business development before moving into the chief strategy role she holds today, keeps an eye on execution.
“There’s this beauty of not having swim lanes,” Ms. Sims said. “She can and should lean into the strategy side, and I understand operations.”
That arrangement requires productive tension that some organizations try to avoid. Not at Ascension; it’s part of the design.
“When you think about the relationship between operations, strategy and finance, that is absolutely key to executing on your long- and short-term plans, and that requires tension,” she said. “It requires transparency.”
The relationship holds even when both leaders are not in the room. They have built a relationship where they’re extensions of each other and collaborate on achieving overall ministry goals.
“I have enough trust, belief and understanding that if Amber’s running it and they’re going down a path, she will take into consideration when I need to be brought into the discussion,” Ms. Deitch said. “It’s a team working toward the same goals and figuring out the best path to get there.”
That trust also creates a modeling effect that neither leader entirely plans for. When teams see executives operating across functional boundaries, it surfaces permission for people further in the organization to do the same.
“When your teams see the relationships between leaders, it’s almost a role-modeling behavior you’re not intentionally trying to do,” Ms. Deitch said. “But they see it, and it starts raising questions in their minds: Who else should I be having this conversation with?”
One of the more concrete expressions of the model is how Ascension thinks about change management. When Ms. Deitch’s team audited how many initiatives were flowing from the corporate office to its markets, the count was close to 1,000, pushing change across an organization of more than 100,000 associates.
“What can the organization actually absorb and do successfully, and where do you start cutting things out?” she said.
Ascension formalized defined periods to protect market leaders’ time for leadership and growth.
“We actually developed no-fly zones, where we can’t go into the markets and we can’t pull people out, so they can actually get work done,” Ms. Sims said. “That rigor around thinking about how much we have going on, and pulling things off the plate where we can, has been part of our success as well.”
The same discipline shapes how Ascension decides what gets standardized across the enterprise and what stays local. The corporate role sets the guardrails and then executives back.
“Our role is to figure out what our standards are going to be and set up the bowling lane,” Ms. Deitch said. “We keep them out of the gutter, but let them run. They need to have free rein to move within that lane.”
The constraint is real. Ascension’s hospitals in Chicago differ meaningfully from those in Nashville — in workforce availability, community demographics and the density of competing services. Uniform prescriptions don’t survive contact with that variation.
Data alignment has been equally important. Before Ascension developed a single set of KPIs tied to its five strategic imperatives, the leadership team spent more time arguing over competing data than acting on it.
“If we’re looking at hospital presidents’ accountability on volume and growth, we’re comparing that volume and growth the same way from one hospital to another, so we’re not using different data sets to disprove each other,” Ms. Sims said. “Before we had that, we were spending so much time just in the data, trying to answer the data and prove the data.”
The model has produced measurable results. Ascension built a national transfer center that connects directly to both operations and business development teams, replacing a fragmented system in which individual hospitals managed their own inbound relationships. Market-level acceptance rates that ranged from 30% to 60% now average nearly 96% across the system.
“We don’t believe all volume is good volume,” Ms. Sims said. “We believe we need to grow the right volume, with the right acuity and the right mix.”
Ms. Deitch put the underlying discipline more directly.
“You’ve really got to narrow the focus and ask: What are the key things we need to drive as an organization? The rest of it is love-to-haves and little projects,” she said.
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