This article first ran in Becker’s COO Report, sent Monday mornings. To subscribe, visit our newsletter offerings, hit the drop down, and select COO Report here.
As COO of Northwell Health, a $25 billion health system, Kevin Beiner has made peace with a job where the work is never finished.
Northwell is 70,000 users into a $1.2 billion effort to move 28 hospitals and 1,000 ambulatory sites off more than 30 legacy EHR platforms and onto a single instance of Epic. One more wave goes live in November. Mr. Beiner is nine months into the COO role after more than 20 years with the system. Asked what he’s looking forward to once it’s complete, he knew better. “There’s no such thing as ‘there’ when you get there,” he said.
He has a point, in more than one way. Epic itself won’t hold still once Northwell arrives. The vendor unveiled dozens of new features at its August user conference, and its release cycle keeps compressing. “Back in the day, we released new versions about every 18 months,” Epic R&D chief Seth Howard said at the event. “Now we release new versions every three months.”
At its core, Mr. Beiner’s line — “no such thing as ‘there'” — is an apt description of the modern COO job. The scale of the role is changing, quickly, and moving the finish line along with it.
Consider the clip of movement in the seat itself. Becker’s tracked more than 30 hospital and health system COO appointments, promotions and exits in about two months — new COOs at systems from Baptist Health in Florida to Carilion Clinic in Virginia, several still stepping into a hospital that hasn’t had a dedicated operating chief before, others taking on one or two more facilities on top of those they already run.
What’s landing on that widening desk isn’t unique to healthcare, either. Boston Consulting Group’s Paari Rajendran put it plainly in a recent conversation on agentic AI in operations: the traditional COO was “the deep technical expert in the company,” the person who knew the supply chain or the floor better than anyone. Across industries, AI agents are now handling more daily blocking and tackling. That’s shifting the COO’s job from doing the technical work to orchestrating it: aligning with the CHRO on how human talent deploys alongside new systems, and with the CIO on platform standards and make-versus-buy calls.
The CEO’s chair is stretching the same way, which only adds pressure from above. When Becker’s asked 23 health system CEOs what belongs in their job description now that didn’t five years ago, the answers ranged from AI governance to cybersecurity to community advocacy — but University of Vermont Health’s Stephen Leffler, MD, gave a telling answer for anyone watching the COO’s seat.
He noted the common belief that CEOs are less hands-on in operations once they earn the top title. Instead, he’s more involved than ever because, in his words, the decisions “really matter for downstream impact.” When a CEO is spending that much time on operational detail, the COO isn’t managing a delegated function anymore. The two roles are converging and sharing priorities and problems.
Every thread points the same direction: bigger platforms, bigger footprints and a job description that keeps absorbing responsibilities other executives once own outright. The COOs living this aren’t necessarily burning out or heading for the door — plenty are staying and taking on more.
But nobody is coasting in this seat, and nobody gets to call the work finished.
That’s the operator’s job in 2026, and it’s exactly what this newsletter exists to track — the platforms going live, the moves being made, and the leaders redefining what running a health system actually means.
Forward this to your fellow operators and orchestrators. And if there’s something you want to see more of in this newsletter, send me a note: mgamble@beckershealthcare.com
At Becker's 4th Annual CEO + CFO Roundtable, taking place November 2–5 in Chicago, more than 1,500 hospital and health system executives tackle decisions that determine whether organizations thrive or merely survive: protecting margins under cost pressure, choosing where to grow, renegotiating payer relationships, stabilizing the workforce and proving real ROI on technology. This is where leaders work through them together, face-to-face. Apply for complimentary registration now.
