Healthcare's Uncomfortable Silence and What It Means for the Next Five Years

I've attended more than a dozen industry events this year alone, spanning healthcare, technology, and clean energy. And across all of them, there is a wild consistency in what has transformed and what hasn't. symplr's Healthcare Operations Summit (HOS) in Chicago was no different. My favorite moment was when symplr's CIO in Residence, Theresa Meadows, said with complete excitement, yet cheeky delivery: "Technology solves everything!"

The room laughed. And then, about sixty seconds later, it went completely silent.

That silence came after two questions were posed to a room of 108 health system leaders representing 2,313 hospitals, 510,000 providers, and $477 billion in revenue:

How many of you have more operational technology today than you did five years ago?

Every hand went up.

How many would say your work and your lives are simpler because of it?

Not a hand in the room.

That gap between the volume of technology investment and the reality of operational life on the ground was the red thread running through every conversation at HOS. And I think it tells us something important not just about where healthcare is today, but about what the next five years are going to demand.

The state of healthcare operations: honest and overdue

Before we can talk about where healthcare is going, let’s take a glimpse into the financial picture that has impacted all of us.  

Year-to-date operating margins for hospitals last year sat at 1.3%. Expenses in Q1 were up significantly year over year. Federal legislation is projected to cut approximately $1 trillion in healthcare spending over the next decade, with January 2027 shaping up as a real inflection point for health systems, particularly those with health plans. Q1 2025 saw 22 consolidation deals, a five-year high, with the majority being divestitures rather than mergers.  

Systems are repositioning, shedding hospitals, and trying to shore up margins wherever they can.

Against that backdrop, the leaders in that room were not talking about moonshots. They were talking about nurse managers spending six hours every day on scheduling and staffing, which means six hours a day is not being spent at the bedside, not coaching their teams, and not spending time with patients. The group discussed UPMC's 23,000 Epic work queues, each requiring a human to manually move data from point A to point B. As discussed, health systems are running between 100 and 250 operational applications, with roughly 20% of leaders in the room unable to name their own number.

Dr. April Taylor, Chief Operating Officer at Johns Hopkins Hospital, put it most plainly: "It's not a technology problem. It really is a challenge with our operating model."

This has been the diagnosis for quite some time, but now we’re seeing an extreme sense of urgency.

AI is real, but so is the ceiling

Every session touched on AI, which isn’t surprising, but there was a clarity to it this year that I didn’t hear in the last few years of the event.

Dr. Rob Bart, Chief Medical Information Officer at UPMC, said something that should be printed and posted in every health system boardroom: "You can spend $100 million on AI and have zero to show for it."

The wins in AI right now, like ambient documentation, are improving clinician retention, patient engagement, satisfaction, and recruitment. Healthcare is adopting AI faster than many other industry verticals, which is a striking reversal of the historical narrative. But as Molly Gamble of Becker's Healthcare observed, those AI wins tend to hit a wall the moment a clinician walks back to their scheduling workflow or their credentialing process. The clinical experience and the operational experience are living in completely different decades.

Dr. Luis Taveras, Chief Digital Information Officer at Jefferson Health, reframed the conversation in a way everyone agreed with: "It is not artificial intelligence. It is augmented intelligence. There always has to be a human in the loop."

This maps directly to something we've built into Greenough's own AI charter. The future is AI-powered, but still human-led. The organizations that will win are not the ones that automate the most, but the ones that are most intentional about where humans remain essential.

The caution from the room was equally clear: don't let vendors define your problem or create a new generation of point solutions in AI that replicates the fragmentation you already have in your application ecosystem. Governance, business cases, and change management are the entire strategy vs. optional add-ons.

Operational infrastructure

Here's what I think gets underestimated in the AI conversation, and what HOS brought to the forefront: you cannot build a smart system on a fragmented foundation.

Bad data produces bad AI. Disconnected systems produce disconnected outcomes. And the operational layer of a health system, like credentialing, workforce management, vendor management, compliance, scheduling, and more inside most organizations, is still a web of patchwork point solutions that don't talk to each other.

Theresa Meadows walked through what consolidation has historically looked like in healthcare: clinical applications consolidated onto EHR platforms, and administrative functions consolidated onto ERP platforms. The next frontier, she argued, is healthcare operations, and it is years behind.

Think about what a connected operational platform could enable.

• A physician contract is executed, automatically triggering credentialing.

• Credentialing completion automatically updates the provider directory.

These examples sound so simple to me, but the reality is, it’s not happening. What sounds like low-hanging fruit are still manual, siloed, error-prone processes in most health systems, and touch four or five disconnected systems, and almost all start on a dated dependency…someone remembering to send an email. 🤯

Soo while AI sounds like a solution to all these problems, these operational issues are actually creating quite a bit of drag on adoption. Agentic AI requires connected, clean, consistent data to function. Building AI on top of fragmented operations doesn't accelerate transformation. It accelerates the wrong things faster, so these are problems that need to be solved before AI comes in and makes it all “better.”

What the next five years looks like

I've been in communications long enough to be skeptical of predictions, but the conversations at HOS gave me a clearer view than most events do. Here's what I think we can expect:

• Operational infrastructure is the real competitive differentiator. Clinical excellence is table stakes. The health systems that pull ahead will be the ones that have done the hard, unglamorous work of consolidating their stack, connecting credentialing to scheduling to compliance, and building the data foundation AI actually requires.

• The middle management layer is where transformation stalls. Executive leaders get it. Frontline clinicians, when engaged properly, embrace tools that improve their lives. The managers who've been doing things a specific way for 15 years are the critical variable – and the most underinvested.

• The workforce conversation needs a reframe. The goal isn't to replace people; it's to replace meaningless, non-value-add tasks. Health systems that communicate that distinction clearly (to nurses, managers, physicians) will have a far easier path to adoption than those that don't

However, the moment that will stay with me longest from HOS is when Bonnie Barnes from the DAISY Foundation took a few minutes to tell the room about her stepson Patrick, who died 26 years ago after eight weeks in the hospital. She reflected on the nurses who held his family together during those weeks. DAISY was created to say thank you, and it operates in nearly 8,000 healthcare facilities across 46 countries.  

She has been my favorite speaker every year, and the story of its mission never grows old, but this year, she addressed AI and soft skills: “the things we used to call soft skills, like a nurse holding someone's hand, the emotional connection in a moment of crisis, these are not soft. They are essential. And they are what all of this infrastructure, all of this technology, all of this operational transformation is ultimately in service of.”

Having this statement stay true and resonate in the next five years isn’t my prediction, but it is my hope.

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