As hospitals nationwide contend with margin pressure and persistent workforce shortages, 56 health systems were named to Forbes‘ annual list of America’s Best Large Employers.

Leaders from several of those organizations told Becker’s they have deliberately protected — and in some cases expanded — investments in leadership development, career pathways, employee well-being and benefits, even as labor costs rise.

Nationwide, labor expresses are increasing across nearly every region and hospital size, rising 5% year over year, according to a Nov. 12 Kaufman Hall report.

Rather than scaling back workforce spending, the executives described doubling down on internal talent pipelines, burnout prevention, employee recognition and programs designed to strengthen retention and engagement.

Below, leaders from 13 of the organizations featured on Forbes‘ list described the workforce investment they refused to cut in a year defined by financial headwinds.

Editor’s note: Responses have been lightly edited for clarity and length.

Alan Kaplan, MD. CEO of UW Health (Madison, Wis.): Our UW Health team provides remarkable care. With demand for our care always growing against a backdrop of national staffing shortages, we realize that following conventional wisdom in workforce development just isn’t enough. We’ve created an innovative set of “earn as you learn” apprenticeship programs we call our career pathways program. Through partnerships with local colleges, community groups and state government, we’ve created apprenticeship programs across key roles like registered nurse, respiratory therapist, medical assistant, nursing assistant, pharmacy technician and ophthalmology technician. Most of these programs were either first of their kind in the nation or first of their kind in Wisconsin, and they enable existing staff to further their careers while still working and at no cost to themselves. They also present an appealing entry point to careers in clinical care for new team members. Despite the national healthcare worker shortage, we’ve seen our retention rates benchmark at the 90th percentile in part due to these innovative programs. Despite the margin pressures faced across the healthcare sector, we’ve continued to invest in these programs, recently launching new apprenticeships for key surgical tech and MRI tech programs, further developing a model for success in a challenging labor market.

Beth Green. CHRO of Cooper University Health Care (Camden, N.J.): In healthcare, financial pressure is real — and that’s exactly why continuing to invest in leadership development matters. When times are hard, strong leadership isn’t a “nice to have,” it’s a necessity.

We know from experience that well‑prepared leaders drive engagement, retain talent, manage resources more responsibly, and keep teams focused on patients — even during uncertainty. Cutting back on leadership development may look like short‑term savings, but the long‑term costs — turnover, disengagement, slower decision‑making and burnout — are far greater.

That’s why we continue to invest in our leaders through formal leadership development programs, individual development plans, leadership assessments such as 360[-degree] feedback and other executive assessment tools and coaching. While we partner with external coaches for our executives, we’ve also built an internal leadership coaching program to support leaders at all other levels — ensuring access to development across the organization.

The return on investment is clear. Leaders who understand financial decision‑making, can adapt to new technology like AI, and know how to lead people through change make better choices every day. Those choices directly affect quality, safety, experience and financial performance.

At Cooper, investing in our leaders is one of the most effective ways to protect our future. When we support leaders, they support their teams — and that’s how we remain strong, resilient and focused on our mission, even in challenging times.

Calvin Allen. Executive Vice President and CHRO of Children’s Hospital of Philadelphia: We believe retention is our best recruitment strategy. When staff feel valued and supported, they become true ambassadors for our mission. During challenging financial times, it may be tempting to cut spending on programs that don’t show immediate returns. However, we see well-being and employee development as essential investments — integral to quality care, safety and our long-term financial health.

Instead of scaling back, we preserved and strengthened our well-being initiatives, with special attention to preventing burnout. Burnout and fatigue, especially among medical staff, lead to higher turnover and disengagement, which ultimately affect patient outcomes. Eliminating these supports might offer short-term relief, but would undermine our stability in the long run. We have clearly signaled to our workforce that their well-being is non-negotiable.

We also safeguarded programs that enrich the employee experience, such as tuition assistance, internal mobility and leadership development. Rather than relying on external hires, we invest in developing internal talent — creating clear career pathways for all employees. This approach boosts engagement, improves retention and reduces reliance on contract labor and expensive recruitment cycles.

By remaining committed to people-focused investments, we ensure a stable, engaged workforce dedicated to exceptional care and service.

Cliff Megerian, MD. CEO of University Hospitals (Cleveland): Despite ongoing margin pressures and rising labor costs, we made a deliberate decision not to cut investment in direct patient care. Protecting the teams who deliver care at the bedside remains our top priority, because maintaining quality, safety and patient experience is foundational to our mission.

Instead of reducing headcount, we formed revenue and expense cabinets that focused on identifying where we were not being reimbursed appropriately for the high‑quality care we provide. This work allowed us to capture revenue we had previously earned but not received. On the expense side, the teams concentrated on eliminating waste, inefficiencies, outdated processes and unnecessary spending that enabled us to keep our workforce intact.

We also accelerated the use of technology to streamline operations and bring work back in‑house, reducing or eliminating reliance on third‑party vendors. These strategies helped us protect critical clinical roles while still strengthening financial performance.

Duane McFadden. CHRO of Children’s Hospital Colorado (Aurora): Children’s Hospital Colorado recognizes the significant pressures created by rising labor costs, talent shortages in key specialty areas and the growing expectations placed on leaders in a highly volatile labor market. Despite these challenges, we believe this is not the time to divest in how we support our workforce. Instead, we have intentionally increased our investment in areas we believe strengthen engagement, retention and long‑term sustainability.

Growing our own talent pipeline: We have expanded programs that reach high schools, colleges and universities, and trade schools to build strong partnerships and create early pathways into our organization. Once team members join us, we support them in defining clear career paths and provide training, education and financial assistance to help them grow within our system.

Leadership development: We believe leadership capability is a critical differentiator in the team member experience. We have increased leadership development opportunities to ensure leaders are equipped not only to manage teams, but to lead in ways that are inspiring, values‑driven and deeply connected to our mission.

Benefits and well‑being: We’ve expanded our benefits portfolio while, in many cases, reducing premiums and out‑of‑pocket costs for team members. These investments are already delivering meaningful improvements in satisfaction and engagement.

Jim VanderSteeg. President and CEO of Covenant Health (Knoxville, Tenn.): When hospitals face financial pressure, it’s tempting to pull back on workforce development. We did the opposite.

Over the past 12 months, we protected our investments in employee growth and career development. We didn’t touch them — because cutting now would cost us the next generation of caregivers.

As a not-for-profit healthcare system, our measurement of success is the pursuit of our mission. Every dollar we save goes back into care. We believe the quality of care depends entirely on the quality of the people delivering it. Every dollar we spend developing our team is a dollar that keeps an experienced caregiver here, growing their skills, instead of leaving.

Laurie Bennett. Vice President of Human Resources at Sarasota (Fla.) Memorial Health Care System: We protected three non-negotiable priorities:

1. Employee engagement and recognition

We continued to invest in programs that reinforce appreciation and belonging, including: Annual service anniversary celebration, honoring milestone work anniversaries starting at five years up to 50 years; dinner program with entertainment and presentation of jeweled pins; monthly excellence recognition, with proclamation and award gifts; employee birthday cards, with coupons to spend at hospital eateries; food truck events, with free meals for all employees; and free tickets to seasonal circus, baseball and other community events.

These initiatives strengthen culture, connection, and retention of our highly skilled team members.

2. Growth and development: We expanded on- and off-site childcare and maintained our tuition reimbursement program, ensuring employees can learn, grow and build long-term careers within our system.

3. Retention of high-performing talent: With nearly 11,000 employees and a growing network of hospitals, specialty care centers and outpatient services, Sarasota Memorial is the region’s largest employer. By prioritizing engagement and development rather than short-term cost reductions, we supported stability across our workforce during a challenging financial environment.

Our commitment to people remains a strategic advantage — not an expense.

Lorina Wise. CHRO of Nationwide Children’s Hospital (Columbus, Ohio): Our continued investment in employee benefits reflects our hospital’s commitment to supporting our workforce. Over the past few years, we have reduced deductibles, minimized increases to employee premiums, and expanded our time-off programs — including PTO, caregiver leave and bereavement leave. We also remain focused on offering competitive wages, and have enhanced our employee assistance program to further support the emotional well-being of our staff and their families.

We continue to invest in events that celebrate our collaborative culture and honor the extraordinary dedication our employees demonstrate every day in caring for our patients and families. This includes employee recognition events, special traditions such as our holiday celebration and hospital birthday celebration, as well as targeted morale‑boosting activities and ongoing culture‑building initiatives. Together, these efforts help create an environment where our team can excel and deliver exceptional care.

Marc Boom, MD. President and CEO of Houston Methodist: Despite all the external turbulence facing healthcare, Houston Methodist is in an excellent financial position to withstand those headwinds. We steadfastly maintain our commitment to supporting our employees. We have robust programs where employees can pursue leadership training, ongoing clinical education and career development opportunities. We want our employees to maintain their purpose and passion for what they do because when they are fulfilled, patients benefit. Protecting these programs strengthens our culture and ensures that we continue providing high-quality patient care.

Mickey Foster. CEO of FirstHealth of the Carolinas (Pinehurst, N.C.): At a time when many healthcare organizations nationwide are facing margin pressure and rising labor costs, FirstHealth views investment in workforce well-being not as an expense, but as a strategic imperative. Supporting our team is essential to sustaining high-quality care for the communities we serve.

Through the Reid Center for Well-Being, we take a comprehensive approach to workforce development by supporting employees’ financial, physical, emotional, spiritual and community well-being. We offer robust retirement plans with matching contributions, on-demand pay through DailyPay and free fitness memberships for all employees. Our WellnessFirst program provides personalized health coaching and financial incentives for achieving wellness goals. Employees also have access to free, confidential counseling from a dedicated staff well-being team that also provides deployable wellness support across the organization.

From financial security, to fitness, to initiatives like partnering with Caring Hearts for Canines to bring adoptable dogs on-site, we are intentional about creating an environment where our team feels valued and supported. When we care for our people, they are better equipped to care for our patients — fulfilling our core purpose “To Care for People.”

Mitchell Rosner, MD. CEO of UVA Health and Executive Vice President for Health Affairs at the University of Virginia (Charlottesville): At UVA Health, workforce investment is not discretionary. It’s central to continuously delivering exceptional patient care and has been a core priority in our strategic plan for several years. Successfully recruiting, retaining, and developing our people is directly tied to patient safety and access and long-term stability, so our focus has been on building talent from within and aligning training with real care needs.

Even while facing margin pressure and rising labor costs, we protected and continued expanding programs that strengthen our workforce pipeline, from entry-level healthcare careers through leadership development. Our nationally recognized “earn while you learn” program provides paid, benefitted pathways into high-demand clinical and technical roles. These program graduates have filled hundreds of positions that have helped stabilize staffing in key areas. Parallel to that, our Health Leadership Institute prepares physicians, nurses, and operational leaders to lead increasingly complex health systems. Together, these efforts help us build a more stable workforce internally rather than relying solely on external hiring in a highly competitive market.

Myra Gregorian. Senior Vice President and Chief People and Transformation Officer at Seattle Children’s: At Seattle Children’s, we know that every person on our team — from our volunteers to our nurses and doctors — are a vital part of delivering healthcare. Despite the financial pressures facing healthcare today, we continue to make investments in our employees. We look at every workforce investment through the lens of our mission: providing hope, care and cures. This past year, we stood firm on investing in employee appreciation, competitive wages, mental health resources and comprehensive benefits, and technology that reduces administrative burden. When our team members feel seen and supported, they bring a level of empathy and excellence to our patients that is unmatched.

Tammy Peterman, MSN, RN. President of the Kansas City (Mo.) Division and Executive Vice President, COO and CNO at The University of Kansas Health System: More than 25 years ago, we developed our guiding formula to focus on quality, people and service. We believe when you have the best and right people supported in the best and right way, good things happen. Our quality outcomes and growth continue to show this is true.

At The University of Kansas Health System, we focus on culture and investment in our people, despite challenging economic conditions in healthcare. We created well-being programs designed to acknowledge the challenges of healthcare and to support mental and physical well-being. Our Employee Support After a Violent Event (E-SAVE) program is a Daisy Award winner for the team’s efforts to provide comprehensive resources to staff after a violent encounter. We have worked to provide additional meaningful benefits, including an additional discretionary holiday.

We created programs to invest in our team’s career development. Our GED program pays for school for eligible team members, gives them time during work hours for study and access to an executive mentor as they work toward a high school diploma. To support nursing, we have several programs including a nurse residency program, an ICU pathway program, and an ambulatory fellowship program. We have also provided a Thanksgiving gift card for all employees.

The post The workforce investments health system execs refuse to cut appeared first on Becker’s Hospital Review | Healthcare News & Analysis.