Dozens of health system executives named different dangers. Nearly all describe the same root problem. Here is what that means for care delivery.
Becker's Hospital Review recently asked hospital and health system executives around the country the same question. What is the most dangerous trend in healthcare today? The responses came from CEOs, CFOs, COOs, and clinical leaders across large systems, academic medical centers, and small rural hospitals. Reimbursement, workforce, artificial intelligence, and trust all came up repeatedly, and each executive framed the danger a little differently. Read the full set of answers together, though, and one pattern shows up again and again. Costs and complexity keep rising. The people and resources available to meet them are growing far more slowly. The gap between the two is where nearly every other problem lives.
A health system CEO described it as a widening disconnect between what communities need and what the organization can sustainably deliver. A rural hospital CEO named the steady loss of access to care as communities lose services one at a time. A CFO described workforce shortages and reimbursement pressure compounding each other until margins become unsustainable. A chief nursing executive pointed to workforce strain, burnout, and financial pressure accelerating together, each one feeding the next.
Every one of these is the same structural gap, described from a different seat in the organization. Reimbursement continues to fall behind the actual cost of delivering care. Experienced clinical staff are leaving the workforce at a pace hiring cannot match. Rural hospitals are absorbing all of this with the least room to adjust. Every executive quoted is watching the same math fail to balance, just from a different department.
Rikki Wardyn, EVP and Chief Experience Officer at Elnera Health, sees the workforce piece of that gap the same way from the inside. "You cannot solve a workforce problem with staffing alone," Wardyn says. "You have to look at the work itself. What are clinicians being asked to do? What should stay at the bedside? What can be supported virtually? What can technology remove or simplify? Sustainable workforce strategy begins by redesigning the work, not simply trying to find more people to perform an unsustainable model."
A few executives named fragmentation directly. Patients moving across multiple systems with limited data sharing. Care that looks efficient on the front end and generates more cost on the back end because no one owns the full picture. A hospital's own operations split into staffing tools, scheduling platforms, virtual care vendors, and workforce software, each one purchased to solve a specific problem and each one running on its own.
"Healthcare does not have a shortage of solutions," Wardyn says. "It has a shortage of solutions that actually work together. Every new technology, staffing model, or clinical program has to make care easier to deliver, easier to experience, and more sustainable. Otherwise, we are simply adding another layer of complexity to an already complicated system."
This is the same pattern Elnera sees inside the health systems it works with. A hospital adds a staffing platform to address staffing. A virtual care vendor gets brought in to address virtual care. The questions that decide whether either one works sit outside both of them: how a nursing unit hands off a patient, how a scheduling decision made in finance affects clinical coverage three floors up, and what happens to a new technology once the vendor's implementation team leaves. Elnera's virtual nursing and virtual sitting services are built to work together as one connected model, because closing that gap has always come down to a structured model connecting the pieces a hospital already owns.
AI came up in a large share of the responses, and the executives who raised it converged on the same point. AI can meaningfully improve access, efficiency, and clinical decision support when an organization pairs it with governance and human judgment. Several leaders described two ways that balance tips over: committing to new tools before the organization has built the oversight to use them responsibly, or holding off entirely while vendors iterate, leaving the underlying workforce and workflow untouched in the meantime.
Elnera's approach treats AI and virtual care as part of a redesigned care model, built alongside the workflow changes it requires. An ambient documentation tool changes what a physician does during a visit. A virtual nursing program changes who is responsible for what during admission and discharge. Those are workflow decisions, and they hold up best when they get made deliberately, as part of assessing and designing the model from the start.
One rural hospital CEO, Tom Vasko of Newman Memorial Hospital in Oklahoma, put a fine point on what's at stake. Fewer than half of rural hospitals nationwide still offer obstetric services, and more than 130 have closed or announced the closure of labor and delivery units since 2020. More than a third of United States counties now qualify as maternity care deserts. His broader point was that rural and urban healthcare function as one connected system, so when rural access weakens, the effects reach communities well beyond the ones losing services directly.
Elnera's model is built to meet hospitals where they are. A care plan for a 25-bed Critical Access Hospital looks different from one built for an academic medical center, and it should. The Elnera leadership team has run virtual nursing and care coordination programs inside health systems of every size, so assessing workforce constraints and existing infrastructure before designing anything is what makes a program sustainable in a rural setting and keeps it in use long after launch.
The executives in this roundup converged on the same conclusion: the fix is structural. Reimbursement models, workforce pipelines, technology investment, and care delivery all have to move together, assessed honestly and designed around the organization's own reality.
Wardyn describes what that looks like when it works. "Healthcare is a lot like an orchestra," she says. "Every part matters, but no single instrument creates the experience on its own. Our clinicians, technology, workflows, operations, and leadership each have a distinct role to play. When those pieces are intentionally designed to work in harmony, we can create something far richer than any one of them could accomplish alone: a care experience that is more connected, more sustainable, and ultimately more human."
Elnera Health guides hospitals and health systems through exactly that work, from an honest assessment of current operations through implementation, scaling, and long-term sustainment. Learn more about how our teams work through our services, meet the people leading that work on our leadership page, or reach out to Elnera Health to talk through what a structured assessment of your operations could look like.