Opening Signal

When everything matters, leadership still must choose what matters most.

Healthcare organizations are not short on important work. Financial pressures, workforce constraints, access needs, technology and AI investments, regulatory requirements, growth opportunities, and community expectations all demand leadership attention, while substantial initiatives and existing commitments are already underway. The challenge is not that these demands lack merit. It is that many of them are competing for the same financial, human resources, and leadership attention.

The pressure created by those competing demands is significant. The American Hospital Association has described financial constraints, workforce strain, and shifting demand as persistent conditions affecting both daily operations and longer-term direction. Hospital expenses increased 7.5% in 2025, while workforce costs represented roughly 60% of total hospital expenses. In an environment like this, leadership cannot assume that every legitimate priority can receive the same level of investment, attention, or urgency.

What Changed

Many of the pressures healthcare leaders are managing are not new. Financial constraints, workforce challenges, access demands, regulatory requirements, and the need to invest in new capabilities have been part of healthcare leadership for years. What has changed is the intensity of many of those pressures and the number of consequential demands that organizations are being asked to address at the same time.

Those demands also increasingly intersect. A workforce constraint can affect access and growth. Financial pressure can alter the feasibility or timing of a strategic investment. New technology may create opportunities while requiring capital, workforce capacity, and leadership attention that are already committed elsewhere.

As a result, organizations may have less room to absorb another important priority without making a corresponding choice about something already underway. The issue is not simply that there is more work. It is that more consequential demands are competing for finite capacity at the same time.

Why It Matters

When several priorities are legitimate, the challenge is no longer simply identifying what matters. Leadership must decide whether the organization can realistically advance all of them at the same time and where its organizational capacity and leadership attention will have the greatest impact.

Without those choices, priorities can begin to compete with one another in ways that are not always immediately visible. Resources may be spread across too many initiatives, consequential decisions may take longer to resolve, and work that once made sense may continue simply because people and resources are already committed to it. At the same time, newer priorities may not receive enough attention or capacity to achieve the impact leadership expects.

Priorities and decisions are also closely connected. As more significant work competes for attention, the decisions needed to move that work forward can accumulate as well. Some decisions appropriately require time and careful consideration, but leadership will not always have perfect information. When consequential decisions remain unresolved, dependent work can wait, risks or costs can continue, and leadership attention remains tied up while new demands continue to emerge.

Research from the Deloitte Center for Health Solutions and the Scottsdale Institute illustrates the tension. Thirty percent of surveyed health system leaders said their organizations were piloting four or more care models simultaneously, while 57% said clearer leadership decisions about what to scale and what to stop would most accelerate progress.

Michael Porter, Harvard Business School professor and strategy scholar, captured the underlying principle in his classic Harvard Business Review article, What Is Strategy?: “The essence of strategy is choosing what not to do.”

For healthcare leadership teams, that does not mean saying no simply for the sake of doing less. It means recognizing that every meaningful priority uses some portion of the organization’s capacity, and that choosing to give one area greater attention has implications for something else.

There is also a human consequence when new priorities continue to be added without corresponding decisions about existing work. Teams may be expected to absorb additional initiatives while continuing to meet current commitments, which can contribute to change fatigue and make it harder for people to understand where their attention should be concentrated.

The NEXTACT Lens

Prioritization becomes meaningful when leadership is willing to make the tradeoffs that follow from its choices. It is not enough to identify what is important or to add another priority to an already full agenda. The more important question is what will change because leadership has decided that something deserves greater attention now.

That may mean shifting resources, reconsidering another priority, moving a consequential decision forward, changing the timing or scope of existing work, or deciding that something else can wait. The point is not to create constant disruption or to stop work simply for the sake of doing less. It is to ensure that the organization’s choices are reflected in how its capacity and leadership attention are actually used.

A useful test is to ask, “What are we changing because of this priority?” If the answer is nothing, meaning no change in resources, attention, sequencing, decisions, or existing commitments, the organization may not actually be prioritizing. It may simply be accumulating more work.

This is also why continuing everything simply because each priority has merit is a choice. When leadership does not make the tradeoffs explicitly, those tradeoffs still occur, but they are often made indirectly through stretched teams, delayed decisions, diluted attention, and uneven progress.

We can’t do everything. So, are we doing the right things?

The answer is reflected not only in what appears on the priority list, but in whether the organization’s capacity, leadership attention, and decisions are aligned with what leadership says matters most.


Janet Henderson, MHA, FACHE
Founder & CEO, NEXTACT Strategy

Resources:

American Hospital Association.Costs of Caring: Challenges Facing America’s Hospitals as They Care for Patients in 2026. March 2026.
American Hospital Association — Costs of Caring

Lemak, Christy; Bill Fera; Anwesha Dutta; Jay Bhatt; Maulesh Shukla; and Madhushree Wagh. “Why Doing Many of the Right Things Still May Not Be Enough to Transform Care Delivery.” Deloitte Insights, Deloitte Center for Health Solutions, June 2, 2026. Research conducted by the Scottsdale Institute and the Deloitte Center for Health Solutions.
Deloitte — Why Doing Many of the Right Things Still May Not Be Enough to Transform Care Delivery

Porter, Michael E. “What Is Strategy?” Harvard Business Review, November–December 1996.
Harvard Business Review — What Is Strategy?

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