From restructuring leadership teams to limiting hiring and adjusting compensation, health system leaders are making difficult workforce decisions that require balancing organizational priorities, financial realities and employee needs.

While the circumstances vary, those decisions often require balancing several competing priorities at once. Becker’s asked three health system leaders: What is the hardest workforce decision you’ve made in the past year, and what did it teach you?

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

Amy Beales. Chief Human Resources Officer for Luminis Health (Annapolis, Md.): The hardest workforce decisions are often the ones that ask people to let go of what has always been in order to build what comes next. During periods of organizational transformation here at Luminis Health, we are trying to standardize practices, redesign leadership structures and create one culture for many. Those decisions aren’t always easy, but they reinforce that successful change depends less on the decision itself and more on how leaders communicate, listen, and bring people along as we strive to be a truly great workplace.

Wendy Fournet, EdD. Executive Vice President and Chief Administrative Officer for Erlanger (Chattanooga, Tenn.): One of the hardest workforce decisions I made in the past year was implementing a more disciplined workforce management process (i.e. a labor council) during a period of significant financial and operational pressure. As part of that effort, we required executive-level review and approval for new positions and backfills across the organization, while balancing the needs of an academic health system with 8,000 employees and the reality of workforce shortages in healthcare.

The challenge was that every leader could make a compelling case for why their position was critical. Patient care, employee well-being, physician support and financial stewardship were all competing priorities. There were times when we had to delay or reconsider positions that departments genuinely needed, even though we understood the operational impact.

What made the decision difficult was recognizing that workforce decisions are not simply about headcount — they are about people, workload, patient access and organizational sustainability. Saying “not now” to a position often meant asking leaders and teams to continue carrying additional responsibilities in the short term.

The experience taught me three important lessons:

Transparency matters. Leaders are much more likely to support difficult workforce decisions when they understand the criteria, the data and the broader organizational context behind them.
Workforce planning must be strategic, not reactive. Every position should be evaluated based on its contribution to patient care, growth, operational efficiency and long-term organizational goals rather than historical staffing models.
People and finances are not competing priorities. Sustainable financial stewardship ultimately protects jobs, allows us to invest in our workforce and ensures we can continue fulfilling our mission for years to come.

While those conversations were difficult, the process strengthened our leadership team’s ability to think strategically about talent and resources. It reinforced that some of the most important workforce decisions are not about adding positions, but about ensuring we are building an organization that can continue to support our employees, physicians and patients well into the future.

Stacey Hancock. Senior Vice President and Chief Human Resources Officer at Archbold (Thomasville, Ga.): The hardest workforce decision I’ve made in the past year was implementing market-based pay adjustments across our system while ensuring internal equity and long-term financial sustainability.

Like many health systems, we were facing significant external pressure on wages — particularly in nursing and other high-demand roles. The data clearly showed we needed to act to remain competitive and retain talent. However, making targeted adjustments introduced real challenges around compression, equity between tenured and newly hired team members, and the broader impact on our overall compensation structure.

The difficult part of this decision wasn’t recognizing the need — it was determining how to do it responsibly. We had to make thoughtful choices about where to prioritize investments, how to communicate transparently with leaders and team members and how to manage expectations when we couldn’t address every concern at once.

What this taught me is that workforce decisions at this level require both discipline and empathy. You have to be grounded in data and strategy, but equally committed to fairness, consistency and clear communication. It also reinforced that there is rarely a perfect solution — only the most responsible one given your mission, your resources and your people.

Ultimately, it strengthened our approach to compensation governance and reinforced the importance of taking a long-term, systemwide view rather than reacting to short-term pressures.

Joline Treanor. System Chief Human Resources Officer at City of Hope (Duarte, Calif.): One of the most complex workforce challenges this past year was helping lead through a period of significant organizational change while balancing the needs of our people, patients and long-term strategic priorities. For a CHRO, moments like these reinforce the importance of clear communication, transparency and consistency, especially when teams are navigating uncertainty.

Most importantly, they are a reminder that every workforce decision affects real people and families. As leaders, we have a responsibility to approach these moments with thoughtfulness and intention, helping individuals navigate what is ahead while keeping teams moving forward with clarity and confidence, guided our values of inclusion, integrity and compassion.

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