Volume 10 (2025-2026)

Patient access and hospital flow remain among the most pressing challenges for health systems today. Emergency department boarding,1 prolonged inpatient stays and delayed speciality appointments create inefficiencies, increase costs and undermine patient experience. Inova Health, a nonprofit system in Northern Virginia, undertook a system-wide transformation to address these challenges by moving from a site-based to a system-based approach. This paper outlines the guiding principles, infrastructure and cultural shifts that enabled Inova to create an integrated ‘access and flow system’. Key enablers included the development of a centralised capacity management team, a system transfer centre, a multispeciality contact centre and digital tools such as self-scheduling, remote monitoring and automated outreach. Organisational change management, including standardisation of processes and a consumer-first mindset, was central to success. The paper discusses the lessons learned in shifting from a holding company model to a true system of care, highlighting the importance of technology enablement, transparency and resilience in leading large-scale change. This experience demonstrates that patient access and flow are not isolated challenges, but system challenges requiring coordinated solutions. The implications for other health systems are clear: meaningful progress requires infrastructure, cultural alignment and leadership commitment. This article is also included in The Business & Management Collection which can be accessed at https://hstalks .com/business/.
Keywords: access; flow; ambulatory operations; capacity management; digital

In response to mounting capacity constraints, rising emergency department (ED) boarding and left-without-being-seen (LWBS) rates and projections indicating the need to nearly double inpatient capacity within a decade, University of Utah Health launched a comprehensive, system-wide Capacity Action Plan in 2022. This case study outlines the strategic shift from a siloed, reactive approach to a coordinated, data-driven and collaboratively governed framework designed to drive short- and mid-term capacity gains while laying the groundwork for long-term, sustainable growth. In its first year, the Capacity Action Plan yielded over 6,800 additional bed days — equivalent to 18 staffed inpatient beds — alongside a 5 per cent decrease in inpatient occupancy, a 1 per cent drop in LWBS, a 2 per cent reduction in ED boarding and a combined US$19.1m in contribution margin and cost avoidance. Year 2 sustained and expanded these results, delivering over 5,200 additional bed days, US$8.3m in contribution margin and US$5.2m in operational savings, while also increasing online self-scheduling by 109 per cent, conducting 10 per cent of outpatient visits virtually and improving radiology and surgical throughput. Beyond outcomes, the initiative catalysed cultural change and operational alignment, with lessons learned around prioritisation, cross-functional execution and adaptability. University of Utah Health demonstrated that capacity expansion does not always require new buildings — it can be achieved through disciplined execution, shared ownership and continuous learning. This case study presents a replicable model for health systems aiming to enhance care access, efficiency and financial resilience in the face of increasingly complex demands. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: capacity; alignment; collaborative leadership; data-driven decision making; action plan; system-wide impact

Hospitals and health systems face mounting pressure to improve patient care while managing workforce strain, rising costs and operational complexity. Artificial intelligence (AI) has the potential to address these challenges. Only 13 per cent of healthcare systems have developed a clear organisational strategy for integrating AI into clinical workflows. Although organisations recognise the need to invest, they struggle to determine where to begin amid numerous options and significant capital requirements. HCA Healthcare has adopted a comprehensive AI strategy — supported by a robust governance framework — to help ensure AI technology is used safely and effectively. HCA Healthcare’s AI strategy emphasises co-design with clinicians, rigorous validation of impact, change management and governance to help ensure that adoption is safe, effective and trusted. This paper presents an overview of HCA Healthcare’s AI strategy, along with four early initiatives that illustrate how AI comes to life in clinical, operational and administrative functions in its hospitals. These initiatives, as well as the strategy behind them, demonstrate how AI can enhance patient experience, support caregivers and improve operational performance. For example, at one site, an AI tool used across more than 1,000 nursing departments cut scheduling time from hours to just 2 to 3 hours per cycle, enabling nurse leaders to devote more time to patient-centred care. HCA Healthcare’s AI strategy ensures that investments in AI balance innovation with accountability to enable sustainable and transformational impact that other health systems can consider. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: artificial intelligence; AI; health care; change management; administration and operations; digital transformation; health technology; healthcare delivery and systems

This paper presents a practical, scalable methodology for addressing persistent healthcare workforce challenges through work redesign. While labour shortages continue to strain healthcare delivery systems, traditional hiring strategies alone are no longer sufficient to address the issue. This paper outlines a replicable approach to increase capacity and resilience by redesigning work processes across both clinical and nonclinical roles. The methodology is built on three components: deconstructing existing work to uncover inefficiencies and hidden capacity; redeploying tasks to align with the optimal combination of human skill and automation; and reconstructing roles to increase productivity, reduce burnout and improve care team utilisation. The approach is grounded in labour data, time-on-task analysis and a clear understanding of change readiness across the organisation. A major element of the framework is the ability to assess the Return on Increased Performance (ROIP), which prioritises redesign efforts by evaluating the strategic value of performance improvements at the task level. The paper also explores how to integrate these changes into systems and culture, ensuring a lasting impact and enabling scalability. A case study from a large academic-affiliated health system demonstrates how the model can deliver tangible results: a 41 per cent increase in capacity in ambulatory operations without adding headcount, achieved by redistributing tasks, standardising processes and automating where appropriate. The paper offers a clear roadmap for rethinking roles, optimising workflows and embedding workforce transformation into healthcare operating models. The framework is evidence based, people centred and built for sustainability. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: healthcare delivery and systems; transformation; administration and operations; capacity management; work redesign; skills; workforce planning; labour optimisation; human resource management; change management

The continuing complexity of the healthcare industry has placed significant pressure on hospitals and health systems, many of which face an uncertain future in an increasingly challenging environment. To tackle today’s challenges, more organisations are turning to consultants for support in identifying and addressing opportunities for strategic, operational and technical improvement. Yet, these engagements inherently involve another challenge, namely ensuring they deliver value. This paper provides a road map for creating effective client–consultant partnerships that deliver targeted results. Supported with real-world examples, the paper outlines common challenges of consulting engagements, such as misdiagnosis of the underlying problem and a misalignment of culture and strategies. It offers guidance on selecting the right consultant, emphasising assessment of prior work and outcomes, determining a candidate’s capacity for additional work and identifying any red flags that may jeopardise the success of the engagement. In addition, the paper presents the important elements of building a successful engagement, including creating a comprehensive scope of work, employing strong project management and maintaining clear and consistent communication. Finally, readers will gain insight into how to structure mutually beneficial fee arrangements and avoid unauthorised additions to the scope of work that can lead to unexpected costs, thereby maximising value and optimising time and expense of the engagement. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.
Keywords: healthcare consulting; consulting engagements; consulting partnerships; scope of work; fee arrangements

Medication management across the care continuum is a strategic imperative for health systems seeking to improve patient safety, clinical outcomes, financial sustainability and operational efficiency. This paper outlines Ochsner Health’s enterprisewide medication management (EMM) strategy, emphasising governance, multidisciplinary collaboration and advanced technology integration as the major drivers of standardised practices across its multistate network. Through system-wide implementation, Ochsner demonstrates that even large, complex health systems can achieve high reliability, safety and efficiency by fostering a culture of collaboration and innovation. The measurable outcomes of this approach underscore the value of a unified EMM model in driving sustainable improvements in healthcare delivery. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.
Keywords: patient safety; operational excellence; zero harm; health system strategy; healthcare innovation; leadership; patient-centred care

This paper analyses Northwell Health’s Eastern Market ambulatory care transformation as a strategic response to healthcare delivery challenges. By examining its regionalisation initiatives, healthcare executives can identify implementable frameworks for their own organisations. The research methodology includes a detailed assessment of Northwell’s structural reorganisation, collaborative care models, technological infrastructure investments and workforce engagement approaches. Findings reveal that strategic regionalisation produced measurable improvements in patient access, care coordination, provider satisfaction and operational efficiency. Success factors crucial to these outcomes include the establishment of defined governance structures, investment in patient navigation services, implementation of streamlined referral systems, development of community-based partnerships and prioritisation of workforce engagement strategies. This case study provides healthcare leaders with practical strategies to restructure their organisations while advancing the quadruple aim of health care. This article is also included in The Business & Management Collection which can be accessed at https://hstalks . com/business/.
Keywords: healthcare regionalisation; ambulatory transformation; organisational restructuring; patient access; care coordination; workforce engagement

The shift from hospital and healthcare leadership to academia is becoming increasingly common among seasoned professionals who seek to extend their impact beyond the clinical and administrative realms. This paper explores the motivations, pathways, challenges and opportunities associated with this career shift. Drawing on the experiences of three healthcare executives who have successfully shifted to academic roles at the University of North Florida (UNF) provides a comprehensive roadmap for practitioners considering a move into academia. It also highlights the unique value that practitioner-scholars bring to health administration education. This shift is not only a career pivot but also a strategic move that allows seasoned professionals to contribute to the academic discourse, influence curriculum development and mentor emerging leaders in health care. As healthcare systems evolve and face unprecedented challenges, the integration of practitioner knowledge into academic settings becomes increasingly vital. Healthcare leaders shifting to academia will encounter a multifaceted journey, exploring personal motivations, institutional pathways and the systemic implications of their move. Understanding the significance of the broader impact on educational quality, student engagement and the alignment between academic programmes and industry needs is crucial for a successful shift. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: healthcare leadership; academia shift educational quality; student engagement; industry alignment; mentorship

Healthcare systems are currently facing a series of urgent challenges, including margin compression, workforce burnout, rising patient expectations and increasing clinical complexity. In this high-stakes environment, alignment between hospital leadership and medical staff is not only essential, but also a matter of survival and success. Effective collaboration depends on engaging both formal and informal physician leaders, who serve as trusted influencers and culture carriers within their teams. Alignment is built on the front lines, not in the boardroom. It requires intentional trust-building, open communication and inclusive decision making. Many systems are still struggling to engage physicians — whether employed or independent — missing opportunities to leverage their clinical credibility and peer influence. Nevertheless, some of today’s top-performing hospitals are physician led, echoing mid-20th-century models where doctors drove organisational success. This paper outlines practical and proven strategies for aligning leadership, strategy and culture through collaboration with medical staff. Major approaches include dyad/triad leadership models, which integrate clinical and administrative perspectives, as well as inclusive governance structures that amplify diverse voices. By involving informal leaders and respected clinicians without formal titles, systems can harness momentum for change through peer-led initiatives. Real-world examples, such as a physician– nurse–administrator triad reducing central line-associated bloodstream infection (CLABSI) rates, demonstrate how these frameworks drive quality, efficiency and trust. The path forward demands more than just a structural fix; it requires a significant shift towards authentic partnership. When alignment is designed with intentional engagement, it transforms performance, retention and patient outcomes. The bottom line is that when formal and informal leaders work together, everyone — patients, staff, and the organisation — wins. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: physician collaboration; physician engagement; operational alignment; triad leadership models; informal leaders; organisational culture

Employed medical groups and their health systems face increasing financial pressure owing to declining reimbursement rates, rising labour costs and rising inflation. Traditional financial reporting, with its focus on bottom-line net income, is not particularly insightful as a gauge of medical group operational performance and does not naturally point to the operational steps necessary to improve financial performance. The 5 Levers Framework is a data-driven, activity-based model developed by Trinity Health that supplements traditional bottom-line metrics with a more operationally driven measure: net investment per relative value unit (RVU), benchmarked against national standards. The framework is grounded in the CMS (Centers for Medicare & Medicaid Services) RBRVS (Resource-Based Relative Value Scale) and evaluates medical group performance across five operational domains: Physician/Provider Portfolio Management, Provider Productivity, Revenue Optimisation, Practice Expense (PE) Optimisation and Provider Compensation Alignment. Each lever is tied to actionable operational metrics. Performance is tracked via real-time dashboards and benchmarked using AMGA (American Medical Group Association) survey data. Application of the framework across 15 regional medical groups led to a US$166m year-over-year financial improvement, an 8-point increase in operating margin percentage and a 7.5 per cent increase in work relative value units (wRVUs). These results demonstrate the framework’s effectiveness in aligning operational drivers with financial outcomes. The 5 Levers Framework offers a replicable, scalable model to more effectively and accurately assess and improve medical group financial performance. It enables health systems to move beyond simplistic financial accounting and towards strategic, data-informed decision making grounded in clinical activity and system value. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: medical group performance; relative value unit (RVU); health system strategy; operational improvement; provider productivity; value-based care

This paper examines how embedding clinical ethics consultation (CEC) into frontline care delivery provides measurable improvements in cost efficiency, clinician moral resilience and patient–family experience. Through illustrative case studies — including those on treatment conflicts and surrogate demands for futile interventions — this paper demonstrates how ethical frameworks facilitate decisions grounded in autonomy, beneficence, non-maleficence and justice. Evidence shows CEC enables significant cost avoidance, with one health system reporting more than US$288,000 in savings over six months, while another study cites annual savings of US$157,000.1,2 Additionally, clinical ethics support contributes to reduced staff turnover, enhanced family communication and improved goal-concordant care. Drawing from implementation experience at Saint Luke’s Health System (now part of BJC Health System), this paper proposes a practical roadmap for clinical ethics integration, ranging from executive sponsorship and resource allocation to committee development and interprofessional embedding. This paper concludes that CEC should be viewed as an operational asset that enhances quality, reduces cost and supports patient-centred decision making. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: clinical ethics consultation; cost avoidance; moral distress; healthcare risk management; care quality; patient-centred care

Artificial intelligence (AI) is reshaping healthcare leadership by combining technological innovation with a focus on human values. This paper examines how AI helps tackle workforce shortages, cost pressures and inequalities. The integration of AI into health care is transforming how services are delivered and managed. As healthcare systems worldwide face significant challenges, such as an ageing population, increasing rates of chronic diseases and rising patient expectations. AI offers innovative solutions to improve efficiency and patient care. In many regions, healthcare providers are overwhelmed, struggling to meet the growing demand for quality services. AI technologies, such as machine learning and natural language processing, are being used to enhance patient engagement, streamline administrative tasks and improve clinical decision making. These tools can analyse large amounts of data to provide personalised care and support, helping healthcare professionals make better-informed decisions. For instance, AI can assist in developing personalised treatment plans, enabling providers to address individual patient needs more effectively. Moreover, AI can automate routine tasks, allowing healthcare staff to focus on more complex and value-added activities, ultimately enhancing the quality of care. Nevertheless, the adoption of AI in healthcare is not without its challenges. Concerns about data privacy, algorithmic bias, and the need for ethical guidelines must be carefully managed to ensure that AI solutions are fair and safe for all patients. By 2030, the vision for AI in health care is to create a more efficient, accessible and patient-centred system. This paper explores the impact of AI on healthcare management, highlighting the opportunities it presents while addressing the necessary considerations for successful implementation. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: artificial intelligence; healthcare management; ethical leadership; predictive analytics; operational efficiency

Community organisations, alternative schools and business institutions worldwide prepare youth for the workforce. Since the COVID-19 pandemic, changes in work—life decisions and business needs have led to a shortage of talent. To equip students with the skills and mindset needed to be future ready, the power of diversity, equity and inclusion (DEI) must be harnessed through a network of meaningful connections and partnerships. A small group at Mayo Clinic, sharing a common interest in DEI and the local community, explored ways to encourage diverse, young talent to embark on careers in science, technology, education and mathematics. Input from community organisations and professionals indicated that collaborating with educational institutions is vital, which led to the initiation of a pilot programme involving one high school. The group collaborated with the school’s Work Experience Coordinator and students to develop and implement a pilot Career Preparation Programme (CPP) as part of a Work Experience Seminar (WES) course to deepen students’ knowledge of healthcare careers and provide one-on-one and group mentorship. Through discussions about career possibilities, levers of success and a higher purpose, the team sought to help students appreciate available and attainable career opportunities. Student evaluations were conducted after each of the two semesters. A total of 93 students participated in the pilot programme, of whom 85 (91 per cent) reported that the combined offering was engaging and worthwhile. The primary takeaways were ‘the importance of soft skills’, ‘following dreams and passions’ and ‘being a lifelong learner’. Inspired by this experience, the students established a club focused on career mentoring and tutoring. Throughout the process, trust, credibility and role modelling were emphasised. In addition, flexibility, patience and openness to bidirectional learning and creative ideas were identified as the main elements of programme’s success. The team plans to expand the pilot programme to include a non-healthcare focus and implement the programme at additional high schools. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.
Keywords: community; diversity; high schools; partnerships; results; talent

In today’s rapidly evolving healthcare environment, effective leadership is
essential to achieving the quadruple aim: improving patient experience, enhancing
population health, reducing costs and promoting provider well-being. This paper examines
the role of values-based leadership (VBL) in meeting these demands through a deliberate,
principle-driven approach. Drawing on the framework articulated by current leadership literature and supported by case studies from NYU Langone and Mayo Clinic, this paper
demonstrates how VBL aligns team behaviour, organisational culture and outcomes
with clearly articulated values. VBL can turn around underperforming teams by unifying
purpose, raising expectations and fostering accountability. When building new teams,
a values-first approach prioritises alignment over short-term productivity, promoting
long-term cohesion and adaptability. Investment in talent — through hiring, mentorship
and leadership development — yields both clinical and financial returns, with organisations
embedding VBL achieving shareholder value and sustainable growth. By integrating
qualitative insights with quantitative outcomes, it is argued that VBL is not a mere soft skill
but a strategic imperative. When values are consistently defined and lived across all levels,
healthcare organisations can weather disruption, attract top talent and deliver exceptional
care. VBL offers a scalable, evidence-based model for leaders committed to enduring,
transformational success. This article is also included in The Business & Management
Collection which can be accessed at https://hstalks.com/business/.
Keywords: leadership; organisational culture; health care; personnel management; strategic planning

This study examines healthcare disparities between rural and urban populations in the United States, highlighting rural residents’ challenges in accessing timely and quality healthcare. These challenges include geographic barriers, limited access to specialists, socioeconomic factors and cultural and linguistic issues. The study analyses the impact of these disparities on health indicators such as chronic disease rates, maternal and child health outcomes and mortality rates. It also explores contributing factors such as social determinants of health, access to preventive care and workforce shortages in rural healthcare settings. The research further investigates the relationship between patient service margin and hospital closures, assessing whether patient service margin serves as a predictor of closure risk. Using secondary data from Missouri hospitals between 2019 and 2022, the study conducted descriptive statistics and paired samples t-tests to evaluate financial performance. The findings reveal that lower patient service margins may indicate delivery challenges, access issues and threats to the viability of rural healthcare services. Financial results vary widely for patient service margins, and these consistently negative margins suggest that rural hospitals have faced financial challenges, impacting their capacity to provide high-quality treatment and access. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.
Keywords: rural; hospital closure; healthcare disparities

This paper outlines Bronson Healthcare’s digital transformation journey to improve System Capacity Management (SCM) and patient throughput. The organisation details the strategic implementation of SCM initiatives to address persistent challenges such as overcrowding, lack of transparency and fragmented workflows. Its major interventions included the launch of a centralised Capacity Command Centre, integration of real-time data tools, standardised interdisciplinary discharge rounds and unit-level huddle dashboards. Thus, Bronson achieved measurable improvements in discharge efficiency, patient flow and operational alignment. The paper examines governance models, communication strategies and cultural shifts that supported sustainable improvements and positioned the organisation for ongoing innovation. This case study offers operational best practices for healthcare systems seeking to leverage digital platforms to optimise hospital operations and enhance care delivery. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: digital transformation; hospital operations; patient throughput; system capacity management; capacity command centre; healthcare innovation

The application of artificial intelligence (AI), large language models and generative AI (GenAI) is accelerating rapidly across many industries worldwide. Innovative models and tools are being piloted to understand their business and societal value. Models such as ChatGPT (OpenAI), Gemini (Google) and Copilot (Microsoft) have become increasingly sophisticated and widely adopted. Understanding the advantages and drawbacks of GenAI models is crucial for organisations seeking to leverage GenAI to maximise their efficiency and expand their capabilities. This paper describes the strategic approach, implementation and findings of using GenAI in a health care business context. A GenAI model was used to analyse and summarise strategic and operational information submitted by external organisations seeking to collaborate with Mayo Clinic. The goal was to reduce process cycle time and manual resource intensity. In parallel, a comparative human review was conducted by functional experts. Both the AI-generated and human-reviewed results were evaluated using sentiment analysis (SA) and then categorised as positive, neutral or negative. Attention was paid to possible inaccuracies and biases associated with the use of the GenAI model. GenAI reduced the manual workload by approximately 20−25 per cent and presented information in a well-structured format. However, the SA showed the GenAI results as positively biased and the human-generated results as neutral. These results were most likely influenced by a positive bias in the input documents, the lack of contextual comparators/ standards in the GenAI model and an inherent bias within the model’s algorithm(s). Additionally, limitations in input size and language translation hindered the GenAI model’s effectiveness. The possibility of AI hallucinations/inaccuracies emphasised the importance of validation by a human expert. Furthermore, carefully formatting the input data enhanced the value and relevance of the GenAI model’s outputs. GenAI has the potential to increase efficiency and alleviate manual burden, but it must be thoughtfully implemented to address inaccuracies, biases and privacy concerns. This article is also included in The Business & Management Collection which can be accessed at https:// hstalks.com/business/.
Keywords: bias; due diligence; generative artificial intelligence; international; models; optimisation

Clinical informatics has emerged as a major discipline in shaping the future of care delivery with the expansion of technology across the healthcare industry. Organisations are harnessing technology more than ever to enhance clinical care, support financial resilience, streamline workflows, reduce administrative burdens and participate in quality and payment programmes; however, it is crucial that the industry does not repeat mistakes from the past with the integration of technology.1,2 This paper explores the changing healthcare landscape, and the crucial role clinical informatics plays in future proofing the system and supporting the quintuple aim with its unique training across medicine, technology and process improvement. There are several best practices and considerations for technology integration, including governance structure, problem identification, team roles and responsibilities, measuring what matters and considering the end-user experience early and often. Additionally, the amount of data being generated across health care today also requires careful handling to minimise risk and protect privacy and security. Organisations that have prioritised these concepts and led with the lens of clinical informatics have seen impact across programmes that leveraged technology for care delivery. Value has been generated through clinical outcomes, patient experiences have improved, access to care has increased and value-based care arrangements have seen success.3 Clinical informaticians are uniquely positioned to guide processes that require the right mix of understanding across people, process and technology to thrive in the ever-changing healthcare environment.4 This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: clinical informatics; healthcare transformation; governance; healthcare technology; clinical technology; healthcare data; value

Innovation in health care is essential to maximise the efficiency of hospital operations, especially in the operating rooms (OR). This case study examines the integration of a visually based ambient intelligence tool in the OR to enhance surgical workflow and patient care through real-time data analysis. The project involved deploying cameras in surgical suites to monitor performance metrics and streamline OR operations. A testing phase was implemented, which prioritised transparency regarding data usage and emphasised a culture of support rather than scrutiny. Pre- and post-implementation surveys were conducted to measure the tool’s impact on OR efficiency, workflow improvements and team dynamics. Overall, the findings demonstrated improvements in scheduling adherence, case duration accuracy and resource availability, indicating enhanced operational efficiency. Despite these gains, some challenges remained, so this underscores the significance of early stakeholder engagement, clear communication and a supportive change management process in the successful adoption of ambient intelligence tools. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: ambient intelligence; artificial intelligence; change management; operating rooms (OR); healthcare innovation; hospital operations

The high level of violence against healthcare workers represents is imperative for healthcare managers to promote a culture of safety, trust and quality patient care. The detailed, practical results of this qualitative exploratory case study provide actionable prevention strategies. The results align with healthcare managers’ perspectives, the challenges faced and the ways to mitigate them. A sample of 20 clinical and nonclinical healthcare workers divided into two groups participated in semi-structured interviews. The results indicated the importance of healthcare workers’ insights in developing robust mitigation strategies. The results also showed a gap in leaders’ focus on workplace safety and the benefit of improved policies and best practices. Four themes were identified, which showed that leaders could improve patient care and workplace violence mitigation strategies. Future research should conduct a deeper review of the quantitative aspects, such as how the frequency of occurrences between different roles and departments influences mitigation strategies, which could further benefit in mitigating the problem. This study provides actionable advice and lessons learned to help healthcare managers develop best practices. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: mitigation strategies; workplace violence; healthcare employee education; de-escalation training; healthcare leaders

Nicklaus Children’s Health System faced numerous challenges, exacerbated by the COVID-19 pandemic, including a shortage of paediatric specialists, workforce burnout and increasing demand for services. In response, the hospital launched the Game Changers programme in 2022, a transformative initiative designed to improve employee engagement, enhance organisational collaboration and reduce costs. Rooted in the Kahn Model of Employee Engagement, the programme promotes meaningfulness, safety and availability among employees, which has contributed to its success. The Game Changers programme involves 100-day ‘workouts’ aimed at addressing crucial issues such as waste reduction, quality improvement and revenue growth, resulting in a financial impact of over US$37m across six workouts. Beyond financial gains, the programme has fostered greater collaboration, developed leadership skills and created a sustainable culture of continuous improvement. The programme’s success highlights the importance of cross-departmental teamwork, senior leadership support and the creation of a positive, engaging environment to drive organisational change. As Nicklaus Children’s continues to evolve the programme, it serves as a model for other healthcare organisations seeking to enhance employee engagement and operational efficiency. This article is also included in The Business & Management Collection which can be accessed at https://hstalks. com/business/.
Keywords: paediatric health care; efficiencies in health care; Kahn Model; employee engagement; leadership development

Site-neutral payment reforms offer a strategic approach to standardise reimbursement rates across care settings, aiming to reduce inefficiencies and enhance fiscal accountability within the US healthcare system. While these reforms target excessive payments to hospital outpatient departments (HOPDs) and promise substantial savings for Medicare and private insurers, they present critical operational and financial challenges for rural healthcare providers. Rural hospitals, already constrained by limited resources and narrow margins, face heightened risks of service reductions and closures under uniform payment models. This paper examines the unintended consequences of site-neutral payment policies on rural healthcare delivery, emphasising how these reforms, without appropriate safeguards, may accelerate hospital-physician consolidation, inflate costs and erode patient choice, particularly in underserved regions. Drawing on empirical data and policy analysis, the study highlights the systemic vulnerabilities exposed by current reform efforts. To address these challenges, we propose a management-focused policy framework that balances cost containment with rural healthcare sustainability. Major recommendations include phased implementation strategies tailored to rural contexts, enhanced federal reimbursement support, preservation incentives for independent physician practices and strengthened antitrust oversight to mitigate consolidation pressures. For healthcare executives, policymakers and system managers, this research underscores the necessity of integrating adaptive regulatory mechanisms and targeted financial interventions to ensure that efficiency-driven reforms do not compromise equitable access to care. A proactive, rural-conscious management strategy is essential to align national payment reforms with the long-term viability and competitiveness of rural healthcare systems. This article is also included in The Business & Management Collection which can be accessed at https:// hstalks.com/business/.
Keywords: site-neutral payment reforms; healthcare market consolidation; rural healthcare access; hospital-physician integration; facility fees

Although healthcare professionals are dedicated to the health of others, they often experience high stress, burnout and low levels of personal wellness. Demanding workloads, long hours and a fast-paced environment can prevent hospital staff from prioritising their own health. This study evaluates the outcomes of a 45-day health and wellness intervention specifically designed for healthcare employees. Using a mixed-methods pre/post design, data was collected over two months from a snowball sample of over 236 participants, including physicians, nurses, pharmacists and other hospital staff. Participants completed self-assessments before and after the intervention to evaluate overall health perceptions, and their daily health habits were tracked through an online platform. A one-way repeated measures analysis of variance (ANOVA) revealed a statistically significant improvement in self-reported health post-intervention (p < .01). Participants also reported increased water intake, higher energy levels and improved dietary habits, including eating more fruits and vegetables. These findings highlight the potential for workplace wellness programmes to meaningfully improve the well-being of healthcare employees. The study offers practical recommendations for health systems to design and implement effective interventions and to identify common pitfalls to avoid. This study contributes to the growing body of evidence on organisational health promotion and provides directions for future research on sustaining employee wellness in high-stress healthcare environments. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: workplace wellness; healthcare employees; health and wellness intervention; employee well-being

Governing boards are key to effectively supporting quality and safety in health systems. A health system’s governing body is ultimately responsible for the quality and safety of care provided in an organisation.1–3 As healthcare systems grow, board governance at the system level, especially as it concerns quality and safety, needs to be routinely evaluated for effectiveness and continuous alignment with the organisation’s values. Boards should be committed to structural innovations and adaptability to ensure they are continually fulfilling their mission of quality and safety oversight on behalf of the patients they serve. In 2019, Keck Medicine of USC created a new health system board governance model. While the process for establishing the new model was relatively straightforward, identifying, implementing and ensuring effective health system governance is a journey of continuous improvement. The new model has resulted in a prioritised ‘voice of the patient’, board members who are dedicated to continuously improving quality and safety, identification of essential processes to oversee key dimensions of quality and safety, creation and effective use of a quality and safety dashboard to drive plans of correction, support for everincreasing performance improvement, discovery and management of internal and external challenges, removal of barriers to effective board governance, promotion of board member alignment and commitment, and routine and deliberative evaluation of board governance effectiveness and the need for ongoing education. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: board governance; quality; governance; systems thinking; culture of quality and safety; quality dashboard; education; professionalism

This paper highlights the University of California Irvine Health’s recognition of and response to an acute need for strategic change based on dynamic market forces, and operational journey through that shift. The paper catalogues the executive team’s pursuit of balanced, systemic change cascading from strategy to priorities through to organisational structure and talent. In particular, the CEO and senior team identified organisational culture as a critical lever for sustainable competitive advantage, enabling significant structural expansion to deliver high-quality care throughout Orange County, California. By January 2026, UCI Health will have successfully integrated four community hospitals into its network, opened two brand new ambulatory centres and added one new, leading-edge 144-bed full-service hospital, for a total of 1,461 beds across six hospitals. The launch and operational success of this expansion relied significantly on the importance of organisational alignment, and the intentional design of culture in the service of strategy. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: strategy; strategic execution; culture; alignment; competitive advantage; transformation

As health care continues to embrace and excel in technological and digital advancements, preventable harm, cognitive and administrative burden, and workplace violence continue to contribute to emotional exhaustion, burnout and loss of joy in our workforce. This has had profound negative impacts on our outcomes and is a barrier to providing the safest care. One solution-based framework that can address and recentre our efforts around safer, more inclusive and transparent health care is the recently introduced Centers for Medicare and Medicaid Services (CMS) Patient Safety Structural Measures (PSSM). These measures consist of the following domains: leadership commitment to eliminating preventable harm, strategic planning and organisational policy, culture of safety and learning system, accountability and transparency, and patient and family engagement. These measures will require us to refocus using available digital solutions to pull from disparate data sources to better enable our leaders and teams to understand the drivers of the context in which we work, identify disparities in healthcare delivery and outcomes, integrate a ‘just culture’, consistently use cause analysis tools and understand the themes and trends produced by these methods, be transparent and rapid in our response to harm with our teams and patients and families, and include our patients and families in the design and re-design of our systems to produce the safest care. The PSSM provide guidance, coupled with an understanding of the principles of human performance and connected data and information, and can restore joy and purpose and create long-lasting sustainable change and improvement in our health outcomes and our organisations. Software solutions offer the promise of implementing this work in ways that reduce the administrative burden and provide valuable actionable insights. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: safety culture; well-being; patient safety structural measures; transparency; just culture; patient and family engagement

Healthcare organisations face mounting challenges to maintain financial sustainability given increasing expenses, decreasing reimbursements and changing patient needs. Because of the increasing costs of operating a healthcare institution, it is no longer viable to pursue achieving financial sustainability just by adding more clinical visits and capacity, increasing hospital admission and throughput, performing more surgeries or simply working harder. To address these challenges, healthcare leaders should adopt a culture of continuous process improvement that engages and empowers clinical and operational teams to identify and eliminate waste, optimise revenue and enhance quality and safety. This paper presents a case study of Project ROSE (Revenue Optimization and Supply Enhancement), a project initiated by a community-based integrated health system in the upper Midwest. The goal was to achieve substantial financial savings within one year through revenue optimisation, supply chain improvements and service and maintenance contract enhancements. We describe the vision, goals, methods, results and lessons learned. We also discuss the implications and recommendations for other healthcare institutions that seek to implement similar initiatives that may reduce the burden on their clinical teams and allow them to work smarter, not harder. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/ business/.
Keywords: healthcare management; revenue optimisation; supply enhancement

The US healthcare system is overwhelmed with staffing shortages, rising costs of care and the overutilisation of emergency rooms and hospitals. Value-based care initiatives work to address these issues, but hospitals, health systems and payers cannot solve these problems alone. Partnerships with post-acute home-based care providers offer specialised, person-centred care aligning with patient and family preferences for receiving care at home. This paper shares details and results from a partnership between Ascension, one of the nation’s leading non-profit and Catholic health systems, and 136 hospitals serving communities in 18 states and the District of Columbia, and Compassus, a leading national provider of integrated home-based care services including home health, hospice, palliative care and infusion. This case study touches on how successful partnership can mitigate various challenges in the healthcare landscape while supporting home-based care, which is projected to experience the most robust growth in post-acute care over the next five years. Readers will learn how Ascension and Compassus designed a mutually beneficial partnership by aligning organisational goals and shared care and quality objectives. The partnership’s success is illustrated through two market examples aimed at improving patient outcomes and satisfaction. The paper also provides recommendations for future collaboration and opportunity, including predictions for how pending legislation could affect the success of similar partnerships and considerations for organisations looking to develop their own value-based care partnership solutions. This article is also included in The Business & Management Collection which can be accessed at https:// hstalks.com/business/.
Keywords: home-based care; post-acute care; avoidable readmissions; value-based partnership; patient-centred care; length-of-stay reduction

Reducing cardiovascular disease (CVD) disparities requires a concerted effort to adopt evidence-based practices (EBPs). Gaps in implementation of EBPs may partially explain persistent CVD disparities. The learning collaborative model provides a platform for discussing, understanding and sharing solutions for evidence-to-practice gaps. The American Heart Association (AHA) integrates multi-facility learning collaboration (LC) initiatives with quality improvement (QI) techniques to close gaps between research findings and clinical practice. The learning collaborative model (LCM) unites multidisciplinary stakeholders around a common goal by using an ’all teach, all learn’ philosophy. Learning collaboratives are designed following an assessment of evidence-to-practice gaps, qualitative and quantitative analysis of gaps in EBPs and the identification of the need and potential for measurable impact and engagement. Implementing the LCM for initiatives led by nationally recognised scientific organisations can improve guideline adherence, set the foundation for ideal care processes and improve patient outcomes. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: learning collaborative; learning collaborative model; cardiovascular disease; evidence-based practices; evidence-to-practice gaps; patient outcomes

This paper explores the concept of values-based leadership in healthcare, focusing specifically on its crucial role in addressing persistent and complex organisational conflicts. Recognising healthcare’s unique challenges and the pressing ‘triple aim’ of enhance revenues, decrease operational expenses and simultaneously uphold care quality, the paper highlights the necessity of leadership that transcends mere managerial competency. Drawing insights from Harry M. Kraemer Jr’s principles, the paper identifies key components such as self-reflection, balance, genuine humility and true selfconfidence as essential for successful healthcare leadership. Readers will gain a nuanced understanding of how effective leaders utilise self-reflection to clarify their core values, prioritise strategically and align their leadership style with organisational goals. Additionally, the paper illustrates how balanced leadership fosters inclusive decision making, considering multiple perspectives to achieve sustainable organisational success. Genuine humility and true self-confidence are further examined as qualities that enable healthcare leaders to cultivate collaborative environments, empowering diverse teams and promoting open, transparent communication. Ultimately, readers — whether clinicians or administrators — will develop a clearer appreciation of how values-based leadership directly contributes to resolving conflicts between financial objectives and social missions, bridging gaps between clinical and administrative personnel and navigating intricate multi-stakeholder dynamics. This knowledge equips healthcare professionals to better foster organisational harmony and advance the triple aim objectives effectively. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: values-based; leadership; hospital administration; humility; self-confidence; balance

As healthcare technology evolves and federal regulations mandate new health IT standards, both payer organisations and health systems are challenged with balancing compliance requirements, internal goals and feasibility. Most organisations aim for better data exchange but meet only the minimum standards due to limited resources and competing priorities. The decision to pivot to a strategic compliance plan that implements a higher standard of interoperability than is required can be a true competitive advantage. Early adopters of new technology standards are sharing proof points and success stories of organisation-wide efficiencies that demonstrate not only the benefits of proactive interoperability initiatives but also the paths that led to their implementation. This paper provides an overview of health IT policy making from agencies within the Department of Health and Human Services (HHS) to help organisations understand the separate but related impacts of final rules released by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). A summary of the requirements of the recent CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) regarding the use of APIs (Application Programming Interfaces), particularly FHIR-based APIs, is included. And, notable changes in the amount of engagement between policy makers and the industry are summarised, such as the HL7 FHIR (Fast Healthcare Interoperability Resources) Accelerator Programme(s), participation in Connectathons and responses to CMS Requests for Information (RFIs) on proposed rules. Real-world application of FHIR-based APIs is highlighted with two case studies involving improved prior authorisation processes. Metrics provided by these health systems support the benefits of proactive compliance and how quickly infrastructure updates can provide a return on investment. An outline for a four-phase strategic compliance plan provides organisations with a guide for their own internal efforts to (a) assess interoperability readiness, (b) align decision makers and set priorities, (c) implement projects and (d) track effectiveness and optimise changes. The paper also summarises recommended tools and resources that are available to support organisations in achieving their strategic compliance planning goals and includes links to additional information that is provided. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: interoperability; health IT policy; data exchange; strategic compliance plans; healthcare management operations