Alison Smith, PhD, spent more than 20 years in HR at Publix Super Markets, a company known nationally for its customer service. Since June 2024, she has applied that background to a different kind of customer relationship as chief human resources officer of Atlanta-based Piedmont.
Piedmont employs nearly 50,000 caregivers across 28 hospitals, 122 immediate care locations and 1,875 Piedmont Clinic physician practices. Dr. Smith, who was CHRO of real estate company Cortland before joining the system, said her time outside healthcare gave her a working understanding of how investment in employees shows up in the experience a company delivers.
“When I think about how that relates to healthcare, in this situation, what you’re delivering is patient care. I come from a background of understanding how what you do to support the workforce translates into outcomes,” Dr. Smith told Becker’s.
In an interview, Dr. Smith discussed what that outside perspective has meant at one of Georgia’s largest health systems, what has surprised her about healthcare and the workforce programs Piedmont is using to plan for growth, develop nurse leaders and absorb new technology.
She said bringing in an HR leader from outside the industry was meant to add a different perspective at the leadership table.
Piedmont President and CEO Kevin Brown “saw the value of having somebody with customer focus, large-scale implementation capabilities and the ability to think strategically,” she said.
Her team works with executives at each of Piedmont’s entities, and she works closely with her colleagues in the system C-suite on where the people strategy fits into problems the organization is solving now and will need to solve later. Part of her own learning curve has been getting close to clinical work.
“I get to be on the floor, and I do a lot of shadowing. I’ve shadowed our patient care techs, I’ve shadowed in the cath lab, and I’ve shadowed across different groups in the hospital to really try to understand what the work is and how the design of the work can continue to evolve to provide better patient care and to work on retention,” she said.
As for what separates healthcare from retail and real estate, she pointed to consequences.
“I would say the stakes are higher here. That’s one way it’s different,” Dr. Smith said. “Your margin for error is lower, and your ability to literally influence lives is significantly higher.”
The range of talent a health system has to hire is also wider than anything she managed before.
“You’re hiring people into an entry-level patient care job, all the way to a very highly specialized skill set, like a chief of oncology who’s working on setting up a great cancer system and running research trials,” she said.
Inside Piedmont’s 10-year plan
Competing for nursing and clinical talent and retaining those employees is among Piedmont’s biggest workforce challenges right now, according to Dr. Smith. That means looking beyond filling the current opening to creating opportunities for employees to grow.
“Somebody might get into nursing because they love to be at the bedside, so how do you continue to provide opportunities for them to grow in their careers?” she said.
Piedmont has built several programs around that question. The system tracks first-year turnover and experience closely, runs a career concierge program and a career pathways program to help employees see and navigate roles across the organization, and over the last year has put specific focus on nurse leadership within its leadership development programs. It is also building career ladders for patient care technicians and pairing technical training with leadership training.
“Nurses have such a big impact on our patients, so anything we can do to better prepare nurses for leadership always pays dividends,” Dr. Smith said.
Those programs sit inside a planning structure that runs from the CEO down. Piedmont has a 10-year plan with annual plans mapped to it, and every leader works from a plan on a page that includes talent goals. HR leaders at each entity are expected to know their numbers, including turnover, agency staffing levels and gaps in filling roles.
“If you ask anyone on the HR team at any entity, they know all their statistics. They’re very engaged. They know what the trends are with who’s staying. They know what the turnover is, what percent of agency we have and where we’re having gaps in filling roles,” she said. “It’s that alignment, reinforced consistently, which sounds easy but is actually really complex to do.”
Technology is another area where Dr. Smith said Piedmont is focused on implementation and workforce preparation. She pointed to technologies ranging from ambient listening to tools that help patients navigate their care. Piedmont uses change champions, employees interested in a given initiative who are trained to help with its rollout, which Dr. Smith said smooths implementation and gives those employees stretch assignments.
“I don’t think you want to move fast just to move fast,” she said. “You have to be thoughtful, but when you know you need to move, you need to move fast.”
She described reskilling as continuous and said Piedmont is working to make its intent clear to employees as roles change.
“We’re also trying to make sure people understand that we’re not focused on eliminating roles. We’re focused on making sure people are doing the value-added parts of the job, which we believe are the patient connection and the things that require judgment and expertise,” Dr. Smith said.
Heading into 2027, her priorities are retention, using technology to improve productivity and experience, and employee health. On the last, she said rising health plan costs are pushing Piedmont to rethink how it supports employee health and to be more proactive about it.
“You do so much to get people hired, so once you’ve made the decision and commitment to someone, assuming that was a good decision, you really want them to stay,” she said. “The stability of the workforce makes everything easier.”
She is also thinking about how the HR function itself needs to change, including how it is structured, what talent it needs and what tools it uses to serve internal customers.
“In addition to what’s happening in the workforce, what is HR doing inside of HR to stay relevant and strategic? That’s something I continue to think about, because the role of HR has changed so much in my career,” she said. “You can’t have Piedmont without people, and I think the same is true for every healthcare organization.”
