Volume 11 (2026-2027)

Healthcare systems across the USA continue to face mounting financial pressures driven by workforce shortages, inflationary supply costs, declining reimbursement rates and growing consumer expectations. Cone Health, a US$2.8bn integrated health network in North Carolina, achieved an unprecedented US$100m margin turnaround in 2023 while reducing nursing labour spend by over US$50m in a single fiscal year. This extended case study synthesises insights from Cone’s system-wide transformation and targeted nursing workforce strategies. Using financial data, organisational frameworks, cultural change methodologies and leadership narratives, this paper provides healthcare executives with evidence-based strategies for financial recovery and operational sustainability. Findings highlight the crucial role of executive leadership, interdisciplinary collaboration, data-driven accountability and cultural transformation in achieving lasting margin improvement. This paper further situates Cone Health’s work within broader scholarly literature, drawing comparisons with other turnaround case studies in healthcare and adjacent industries. It also provides extended implications for governance, leadership development, equity and long-term cultural resilience. The analysis aims to serve as an academic contribution and a practical resource for executives navigating financial recovery in complex healthcare environments. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: financial turnaround; contract labour; length of stay; labour optimisation

Hospitals increasingly face complex financial decisions that shape both care delivery and revenue generation; yet, the relationship between financial structure and hospital performance remains poorly understood. Using facility-level quarterly data from Californian hospitals between 2024 and 2025, this study examines how capacity, financial leverage, outsourcing expenditures and financial asset holdings relate to two distinct performance measures: total patient days and total net patient revenue. Hospital fixed-effects models are estimated to capture within-hospital variation over time. The results reveal that total liabilities are positively associated with both patient volume and net patient revenue, suggesting that financial leverage may reflect expansion-oriented investment rather than financial distress. In contrast, purchased outpatient service expenses are negatively associated with both outcomes, indicating a potential substitution away from inpatient activity. Marketable securities show no relationship with patient days and a negative association with net patient revenue, highlighting a disconnect between financial asset accumulation and revenue-generating care. Together, these findings suggest that hospital financial strength does not uniformly translate into greater care delivery, underscoring important trade-offs between expansion, efficiency and financial security. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: hospital performance; financial leverage; hospital capacity

Leadership development is crucial in healthcare, where strong guidance has a direct impact on patient safety, organisational efficiency as well as workforce engagement and retention. In the dynamic healthcare landscape, physician leaders play a crucial role by blending medical expertise with management skills, benefiting their organisations and fostering healthier teams. Traditional medical education, however, often lacks adequate leadership training. Rady Children’s Health, Orange County (previously known as Children’s Hospital of Orange County) launched a Leadership Physician Certificate Programme (later renamed the Medical Staff Certificate Program [MSCP]) to address gaps in leadership preparation and succession planning. This paper explores the inaugural programme’s journey from concept to successful implementation, including structure, outcomes and implications for healthcare organisations seeking to strengthen physician leadership pipelines. Using Rady Children’s Health, Orange County’s MSCP as a case study, this paper examines how a strategic focus on leadership competencies and organisational alignment informed the development of a curriculum that fosters engagement and prepares future leaders, ultimately enhancing patient care outcomes, physician satisfaction and retention. It also explores how leadership programmes can be tailored to address the unique needs of individual healthcare systems. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: physician leadership development; paediatric healthcare; succession planning; competency-based training; organisational innovation

The demand for anaesthesia continues to grow, with procedures becoming more complex and involving higher-risk patients. Pre-anaesthesia evaluation (PREANE) is essential for risk stratification, optimisation and decision making, yet inadequate preparation often leads to the cancellation of elective surgeries. This study examined challenges in preoperative management within Spanish hospital anaesthesiology services, focusing on last-minute cancellations (LMCs), bottlenecks and hidden workforce burdens. Qualitative interviews were conducted with 18 heads of anaesthesiology departments to identify inefficiencies in perioperative care. The major issues found were staff shortages, inconsistent preoperative circuits and poor preparation (PPP), which sometimes led to surgeries performed under suboptimal conditions. Among hospitals reporting data, the average LMC rate due to PPP was 1.82 per cent, equating to nearly 66,600 cancelled procedures annually across Spain’s public health system. Cancellations most often stemmed from unreviewed preoperative recommendations and insufficient staffing for evaluations. Interviewees linked LMCs with hospital inefficiency and negative patient outcomes, including prolonged stays and higher complication rates. Findings revealed a 10 per cent deficit in anaesthesiology staff and frequent reliance on non-medical personnel for assessments. Most hospitals lacked key performance indicators (KPIs) to monitor suboptimal surgeries, although adverse outcomes could be inferred from increased intensive care use and lengthened hospitalisations. The study concludes that systematic data collection, standardised PRE-ANE pathways and better alignment of resources are essential. Integration of AI and machine learning into preoperative processes may further improve patient selection, reduce cancellations and strengthen departmental workflows. This analysis offers healthcare managers a reference framework to address inefficiencies and proposes actionable strategies for enhancing preoperative management in Spanish anaesthesiology services. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: pre-anaesthesia evaluation; perioperative management; surgery cancellation; anaesthesiology workforce; patient safety; artificial intelligence

Provider retention is vital for a healthcare organisation. The intake and integration process for providers into the organisation sets the tone for the experience the provider expects to have throughout their job tenure. Often, this intake and integration process — onboarding — can be clunky at best and completely dysfunctional at worst, leaving providers confused and frustrated, claims unpaid and function leaders wondering what went wrong. The 120-day period before a provider sees their first patient is when functions like recruitment, human resources (HR), information technology, enrolment, credentialing, privileging, risk, compliance and the medical group are all racing to complete their siloed processes. But, organisational alignment, smart use of existing assets and technology as well as a strong desire to keep the provider’s experience at the centre of it are the pillars of success of an onboarding programme. This paper details the experience at Bon Secours Mercy Health and how they methodically addressed all aspects of the onboarding process to successfully overcome one of health care’s silent revenue-killing challenges. The paper will review the five-phased approach used to successfully implement a new onboarding programme and the specific metrics used to measure results, including a 17-day reduction in the overall time a provider spends in the process, 70 per cent reduction of claims denials attributed to credentialing delays and 92 per cent of providers starting on time by the end of the pilot. Not only are providers submitting their applications faster than ever, but also applications are no longer returned for correction, thanks to auditing by an assigned onboarding concierge. Closely coordinated functional teams are thriving with clearly delineated responsibilities. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: provider onboarding; credentialing; privileging; payer enrollment; transformation; retention

This article examines equity as a strategic organisational factor influencing workforce stability, patient safety ,and resilience in healthcare organisations. Drawing on industrial and organisational psychology, organisational behaviour, and healthcare leadership research, the article synthesises evidence on how inequitable workplace conditions, including mistreatment and microaggressions, information asymmetry, biased standards of competence, and tokenising hypervisibility, can contribute to organisational risk. The analysis identifies psychological safety, organisational justice, identity threat, and resource depletion as key mechanisms through which these conditions influence burnout, disengagement, and turnover intention, with downstream implications for staffing stability, operational costs, care quality ,and organisational performance. To integrate these relationships, the article introduces the Equity-Resilience Organisational Framework (EROF), a conceptual model linking systemic inequity exposures to psychological and social mechanisms, workforce instability, and organisational consequences. The analysis indicates that equity is most consequential when embedded within core organisational systems rather than addressed primarily through discrete or symbolic initiatives. Evidencealigned pathways include inclusive leadership development, equitable evaluation and promotion systems, transparent communication and information access, structurally focused workforce well-being policies, and accountability mechanisms linked to governance and executive performance. The article concludes that operationalising, measuring, and governing equity as strategic infrastructure can strengthen workforce stability, support patient safety ,and enhance organisational capacity to adapt under sustained operational strain. The EROF provides healthcare executives and governing bodies with a practical framework for diagnosing organisational risk, prioritising interventions, and evaluating their impact over time. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
Keywords: strategic leadership; organisational resilience; healthcare workforce stability,; equity as organisational strategy; women of colour; patient safety and performance