Across health systems of vastly different sizes, structures and missions, a set of common organizational instincts is beginning to coalesce. Margin compression, workforce shortages and AI adoption have each created pressure to act.
But the redesign taking shape among health system leaders is less about redrawing org charts and more about aligning structure to the functions that are already shifting fastest.
“‘Form follows function’ is the right guide when evaluating organizational structure,” Ric Ransom, CEO of University of Missouri Health Care in Columbia, Mo., told Becker’s. “The functions we see evolving fastest are ambulatory care, information technology and finance and revenue cycle.”
At Mizzou, that principle has already produced a triad model for business unit oversight in both ambulatory and inpatient settings and streamlined leadership layers to keep decision-making close to the work. The patient billing process illustrates how the redesign is translating into operations.
“A patient seeking care shouldn’t have to work with multiple teams to manage an account, and a centrally managed approach is better for patients and more efficient,” Mr. Ransom said.
That same transformation is taking shape across systems that look very different from Mizzou. Bob Riney, president and CEO of Henry Ford Health in Detroit, said a more integrated and agile system with faster decision-making and clearer accountability will be most successful in the future. It’s not just all about scale.
“We will continue to standardize functions where scale improves quality, efficiency and affordability, while maintaining the local leadership and responsiveness necessary to meet the needs of the communities we serve,” Mr. Riney said. “We anticipate leveraging technology, analytics, automation and artificial intelligence to redesign work where possible and better support our workforce, allowing team members to focus more of their time on activities that create value for patients and consumers.”
For academic health systems, the redesign also includes aligning clinical, education, research and innovation enterprises that often don’t share legal or financial structures. Jeffrey P. Gold, MD, president of the University of Nebraska System in Lincoln, said the flexibility that will allow academic health systems to respond to change starts with talent, not organization charts.
“The healthcare organizations that succeed through 2030 will be those structured to respond to change while remaining grounded in their mission, accessible, affordable high quality care,” Dr. Gold said. “That flexibility starts with recruiting and retaining exceptional talent, bringing together the right people in the right roles to build strong teams, and investing in the resources and opportunities that allow these talented individuals to succeed.”
Dr. Gold pointed to artificial intelligence as a test case for whether the new structures being built can support meaningful adoption rather than merely accommodate it.
“Realizing its potential in healthcare requires the right people and partnerships to identify where it can meaningfully support high quality clinical and administrative work and improve how we deliver care without diminishing the human touch,” he said.
At Emerson Health, an independent community health system in Concord, Mass., President and CEO Christine Schuster, RN, is navigating the same redesign with different constraints. Without the scale of a large integrated network or an academic medical center, Ms. Schuster is aligning leadership responsibilities more tightly across operations, workforce planning, financial performance and business development, and building AI oversight directly into that leadership structure from the start.
“As technology and AI become more integral to care delivery and administration, we will embed oversight into our leadership and governance structure, focusing on quality, measurable value, and responsible adoption,” Ms. Schuster said.
Not every executive sees structural change as the central mechanism. Nikki McLain, CFO of Piedmont Augusta (Ga.) Hospital, said the redesign of her organization is focused on how people work within the organization chart.
“Our focus will be on deepening collaboration among clinical, operational, financial, and support teams, ensuring we remain aligned around shared goals and priorities,” Ms. McLain said. “Ultimately, our organizational evolution will be defined not simply by structure, but by how effectively we collaborate, invest in our people, and stay aligned around the needs of our patients and communities.”
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