The Health System Leadership Bench Is Carrying More Than the Numbers Show

When Becker’s Hospital Review asked health system CEOs about burnout this year, Lee Health CEO Larry Antonucci, MD, named something different than long hours. He described “the feeling of being stuck”: leaders pouring maximum effort into their organizations and still watching it get harder to advance the mission. Loyola Medicine’s Shawn Vincent put it in four words. What was once occasional stress has become “sustained fatigue.”

I have spent two decades in healthcare workforce and leadership development, and this matches what I hear in rooms where executives speak candidly. The exhaustion at the top of our health systems has changed character. It is a crisis of meaning and momentum as much as workload. And it is reshaping the entire leadership bench, from the C-suite down to the newest nurse manager.

Here is what the evidence actually shows, and what it means for how we support these leaders.

The pain is real, documented, and layered

Isolation is structural. Research published in Harvard Business Review, drawing on RHR International’s survey of 109 CEOs, found that half of chief executives report loneliness in the role, and 61% of that group say it hinders their performance. Among first-time CEOs, nearly 70% say it hurts their performance. The board is rarely a safe place to show uncertainty. Peers run competing systems. Direct reports need their leader to project confidence. The seat is designed to be lonely.

Moral distress has moved up the org chart. HealthLeaders, reporting on research by Rose Sherman and Angela Prestia, found that chief nursing officers describe making decisions “against their value systems” on staffing, ratios, and budgets, and carrying that weight in isolation. These are people who entered healthcare as a calling. The gap between their values and their required decisions is a distinct injury, and traditional leadership training does not touch it.

The bench below them is unstable, and they feel responsible for it. AONL’s 2025 Nursing Leadership Insight Study of nearly 3,000 nurse leaders found that 46% are weighing a significant career move. AONL and Laudio have also documented that a single nurse manager departure is associated with up to a 4% decline in RN retention the following

year. Gallup’s long-running research holds that managers account for 70% of the variance in team engagement. Executives know these numbers. They watch director turnover and understand exactly what it costs, in dollars and in trust.

They have already spent money on solutions that disappointed them. McKinsey’s survey of more than 500 executives found that while roughly 90% of organizations invest in leadership development, only about 10% see clear ROI. The failure pattern is consistent: one-time events instead of sustained processes, generic curriculum, no connection to the business results the board actually watches. Every executive reading this has sat through at least one of those programs. Their skepticism is earned.

How this bench actually gets better support

The same McKinsey research points to the fix. Organizations with successful leadership development were eight times more likely to focus on the specific behaviors executives believed drove business performance. That finding should shape everything we build for this audience.

Support that works for senior healthcare leaders shares a few traits. It is sustained over months, because behavior change regresses without reinforcement. It is diagnosed, meaning it targets the actual gaps of the actual leader (a new COO in her first six months needs something different than a CNO carrying a wave of director resignations). It is measured against the metrics the board already tracks: retention, engagement, turnover cost, succession readiness. And it includes a genuinely confidential space, because the loneliness data tells us these leaders have almost nowhere to think out loud.

Timing matters too. The moments when leaders are most open to support are predictable: the first year in a new seat, the months after a merger, a failed engagement survey, an unexpected departure that exposes the succession pipeline. Organizations that invest at those moments, rather than after the damage compounds, get a very different return.

This is the reason I built Wildbrush Collective around both structure and identity. Strategy without values alignment produces leaders who execute and quietly empty out. Values work without accountability structures produces inspiration that never moves. Healthcare executives need both, and most programs offer one.

What you need to know if you lead alongside these leaders, or work within these systems

If you report to, partner with, or sit on a board with a system executive right now, a few things are worth understanding.

Their composure is a job requirement, and it hides the load. The confidence you see in the leadership meeting is professional discipline. The loneliness research suggests you should assume more strain than they show, especially if they are new in the role.

Layoff seasons injure the people announcing them. When your executive says “these are tough and complex decisions,” the CNO moral distress research suggests you take that at face value. Many of them are making calls that conflict with the reasons they entered healthcare. A little grace, and a little directness about what your team actually needs, both help.

Your retention is their scoreboard and their conscience. If you are a director or manager, know that your departure ripples. The AONL data ties manager exits directly to frontline turnover. Executives carry that math personally. Telling your leader what would keep you, before you have one foot out the door, is one of the most useful things you can do.

Bring solutions with the metrics attached. If you are proposing anything to this audience, from a staffing model to a development program, connect it to retention, engagement, or cost. They have been burned by initiatives that promised transformation and delivered a binder. Evidence is how you earn the meeting.

Check on the strong ones. The most dangerous exhaustion in these systems belongs to the leader with the full calendar and the spotless reputation. Nobody asks if she is okay. Be the person who asks.

The leaders holding our health systems together are doing some of the hardest institutional work in the country right now. The data says they are stretched, isolated, and skeptical of easy answers. They deserve support built with the same rigor they bring to everything else.

If you lead in one of these systems and any of this sounds familiar, I would genuinely like to hear what it looks like from your seat.

Anna Smith, MHA, CPTM, is the founder of Wildbrush Collective, a boutique leadership institute serving healthcare organizations nationally from Missoula, Montana.