When Nakesha Lopez became chief people and culture officer at Advocate Health in 2024, the Charlotte, N.C.-based system was still working through the integration that followed the December 2022 combination of Atrium Health and Advocate Aurora Health. It was also changing at the top.
Gene Woods had led the system as co-CEO alongside Jim Skogsbergh since the combination was finalized, under a timeline set at the merger for Mr. Skogsbergh to serve 18 months. He stepped down May 31, 2024, leaving Mr. Woods as sole CEO as he began rolling out his strategy across a footprint that now spans six states and more than 165,000 employees.
Two years in, Ms. Lopez describes the period since as one of transformation, cultural alignment and integration, with accessibility and redefining care at the forefront.
“And for us to do that, we’ve really been working through how we make sure we are building platform solutions and access for all of our communities and patients, regardless of where you access services from us,” Ms. Lopez said. “We’re in multiple states, and to do that, I think the core of that is cultural alignment and your teammates really being aligned to the vision of where you’re going. That’s been the focus for us over the last two years of painting that vision; we’ve had new purpose and commitments that we’ve rolled out to our teammates, really anchoring them to our organization, a recommitment to this new vision and our strategy.”
She said Advocate Health is also focused on keeping employees at the center of that shift, ensuring experiences feel equitable across the organization and that leaders are listening as the transformation evolves. She sees organizations across industries wrestling with similar workforce questions.
“What does workforce transformation look like in the future, and how do they wrestle with this conversation? Where does AI come into the mix with labor pressures and financial pressures that are hitting almost every industry?” Ms. Lopez said. “How do you keep humans in the loop, people in the loop, and at the center and the core of it? And I think that’s going to be the key balancing act organizations are going to have to make today, tomorrow and into the future.”
Advocate’s answer includes a redesign strategy it calls Work Forward. In practice, it means looking at the work teammates do, identifying barriers that can keep them from delivering high-quality care and interactions and redesigning workflows to address them, Ms. Lopez said. It also means identifying skills the system will need that it does not have yet. All teammates are eligible to take part and bring forward ideas for improving their work.
“If our purpose is to redefine care, we can’t redefine care if the work looks the same, if the skills look the same,” Ms. Lopez said.
AI and technology are intended to accelerate that work.
“The other part of Work Forward … is how do we leverage AI and technology as an accelerator or an enabler of that goal? It’s not the center point of that goal,” Ms. Lopez said.
That approach also shapes how the work is led. Ms. Lopez works alongside Andy Crowder, Advocate Health’s senior vice president and chief digital and AI officer, on the strategy. She said the pairing of the people function and the AI function has to be the model going forward, and that the more common approach, including at Advocate in the past, has been to let IT identify a technology and implement it against a single problem.
“We’ve got to have a pair of the chief people and culture officer, my role, and the chief AI officer working together as strategic partners and operational execution partners as well, and our teams alongside it,” she said.
The two functions begin with use cases and challenges the organization wants to address, and what its workforce data says about where skills and roles are heading. Leadership teams are then brought together to identify workflow opportunities, with the AI and IT teams building alongside them while the people and culture team maps what the work looks like afterward and how the workforce gets reskilled for it, Ms. Lopez said. Under a more traditional technology implementation, she said, HR can be left catching up after a tool goes live.
“We don’t even talk about what’s the job of the future or how the job has changed. Do we need to update the job description?” she said, describing the traditional approach. “So it’s opening up a door of a very much more end-to-end workflow of how we will partner together.”
Ms. Lopez said Advocate is not the only system working this way, but that organizations that do will end up with a better product because they are solving for the full sequence of work, technology and future skills.
Inside the HR function itself, every area carries a prioritized AI focus, and teams have access to Microsoft Copilot with guardrails on its use. Ms. Lopez pointed to a recent example from her culture and experience team, which built a standardized format for reviewing engagement survey results function by function, giving leaders a customized view of where to lean in and what questions to ask.
“It was almost like a starter pack for me to help me engage in these much more fruitful, thoughtful conversations with each of my leaders,” she said. “We didn’t have to tell that team to go do it.”
Elsewhere in the function, the system has pilots underway in talent acquisition around phone screening, work in its HR service center aimed at faster answers for teammates, and agent-based well-being coaching, with new AI coaching offerings soon to roll out.
The larger, unfinished piece is forecasting. Ms. Lopez said Advocate Health is combining internal demand modeling around clinician capacity and access with a newer ability to project supply by role, skill and geography down to individual hospitals and clinics, then filtering both through the system’s growth strategy.
She is candid that the capability is still being built.
“We’ve not hit all the goals we have yet,” she said. “We will achieve them.”
The near-term payoff is better budgeting and clearer recruiting targets by market. The longer-term ambition is internal. Some of the roles and skills the system will need are ones it does not have and may not be available in the market at the scale its growth requires, which pushes the question toward existing employees and whether their skills can be repositioned. Ms. Lopez said the missing input is the teammates’ own intent.
“We don’t even know if our teammates want to do something different tomorrow,” she said.
The vision is to pair skills data with those conversations, including for teammates who cannot yet name the role they want.
“These skill sets that you have, as you just told us you have, we think you could also do X, Y or Z. That unlocks, I think, a totally new avenue of conversation and richness of dialogue between a leader and the teammate,” Ms. Lopez said.
The same measurement discipline is being applied to the system’s newest nursing pipeline. As part of a collaboration Advocate launched in June with Covista, the organizations have paired a scholarship toward a BSN degree from Downers Grove, Ill.-based Chamberlain University with clinical experience inside Advocate facilities and loan repayment support once graduates are employed. The program establishes an acute and progressive care nursing pathway, and the system has said it expects to serve hundreds of students a year. Ms. Lopez said the system is tracking learner progression, program completion, employment conversion, retention after conversion and long-term workforce sustainability, and comparing cohorts that came through the program against those that did not.
“We’re not looking at a single metric,” she said. “We are really trying to look at the entire pipeline and what are key measures along that pipeline that tells us we’re successful along the way.”
Asked what she would tell other health system executives navigating the same conditions, Ms. Lopez pointed to two complementary elements.
“The consistent theme for me is leadership and listening,” she said. “Leaders in general have such an impact on organizational culture, on teammate retention, on teammate engagement. Leaders really matter. Core to that, though, what I’ve seen and experienced is the ability to listen, connect and translate. And not all leaders do that well.”
That, she said, holds regardless of what the organization is enduring.
“Starting with listening: How are you translating to your teams? Where the organization is going, and where that team and the team’s role in that vision is important, and solving with them for the experiences and the obstacles in their day-to-day work, that is key, regardless of whether you’re doing big transformation, whether you’re doing integration, or you’re just surviving,” Ms. Lopez said.
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