BUILT TO LAST
How hospitals can thrive amid intense pressure
Kara Brooks sees it every day. Today’s hospitals are being asked to do more with less. From managing rising patient volumes and workforce shortages to balancing financial performance with mission-driven care, healthcare leaders are being challenged to deliver greater efficiency without sacrificing quality.
Brooks, Senior Associate Director, Sustainability, American Hospital Association (AHA), believes the path forward requires more than incremental improvements. The strategy calls for rethinking how hospitals operate, finance and sustain themselves for the long-term.
This is where sustainability and operational resilience converge. For many organizations, sustainability has evolved beyond energy savings or recycling programs, today representing a strategic approach to building organizations that are efficient, adaptable and capable of serving their communities despite external pressures. “The pursuit of sustainability is not separate from the hospital mission—it is core to protecting human health and building community resiliency,” says Brooks, MS, LEED AP BD+C.
AHA underscores this point in its Health Care Leader’s Guide to Sustainability and Environmental Stewardship, a toolkit of tangible action items for CEOs, boards and trustees, sustainability teams, COOs and CFOs. The guide—which highlights both the urgency and the opportunity for hospitals to lead—demonstrates how each can lead the charge in environmental stewardship.
“The pursuit of sustainability is not separate from the hospital mission—it is core to protecting human health and building community resiliency.”
— Kara Brooks, Senior Associate Director, Sustainability, American Hospital Association
The data is sobering. The U.S. healthcare sector is responsible for 8.5% of the nation’s carbon emissions and 35% of global healthcare emissions. Even more striking, 80% of those emissions are tied to the supply chain—everything from pharmaceuticals and food to transportation and outsourced services. For hospitals navigating razor-thin margins, the figures reveal more than environmental concerns—they highlight inefficiencies and hidden costs across daily operations.
“Addressing them is not only about reducing emissions, but also about creating healthier, more financially stable organizations,” Brooks says. “Eighty percent of healthcare’s emissions stem from the supply chain. Addressing procurement, food, pharmaceuticals and transportation is essential to meaningful progress. Sustainability is not separate from the hospital mission—it is core to protecting human health and community resiliency.”
The American Hospital Association is calling on hospital leaders to establish baselines, set time-bound goals and engage cross-functional teams that align clinical, financial and operational strategies around measurable outcomes. Putting this strategy in practice means optimizing procurement processes to reduce waste, improving building energy efficiency or redesigning transportation systems to lower both emissions and costs.
Equally important is the cultural dimension. Hospitals that empower employees across departments to participate in sustainability efforts often see gains in engagement and retention, as staff feel connected to a broader mission. For boards, CEOs and CFOs, linking environmental stewardship with operational strategy also provides a framework for smarter long-term capital allocation, helping systems weather financial and regulatory pressures more effectively.
Sustainability is just one piece of the broader resilience puzzle. Hospitals must also streamline patient throughput, reduce inefficiencies and strengthen clinical alignment with cost-containment goals. Many are rethinking care models to improve flow, from admissions to discharge, while adopting data-driven approaches that reveal bottlenecks and opportunities for resource optimization. Interdisciplinary collaboration—whether in sustainability initiatives or throughput redesign—remains a common denominator for success.
Taken together, these strategies reflect a new mindset for healthcare leadership. Hospitals that embrace operational resilience and environmental stewardship are not only responding to today’s pressures; they are positioning themselves to thrive in the future. By reducing waste, optimizing resources, and mobilizing their organizations around shared goals, health systems can create a more sustainable and resilient ecosystem—one built to last.
“Healthcare contributes significantly to U.S. emissions, but hospitals also have the opportunity to lead on climate solutions that directly improve community health,” Brooks says. “Tracking and reducing emissions isn’t just about compliance. It builds value through stronger employee engagement, smarter capital allocation, and improved long-term outcomes.”
Leading the charge
Neal K. Shah has a simple, but sobering way of framing the challenge ahead for today’s healthcare providers: You must reduce costs by 15% to 20% by 2030—all while investing in the resilience that will carry them into the future. “It’s a paradox for leadership,” says Shah, CEO of CareYaya Health Technologies in Raleigh, North Carolina. “How do you cut costs while building for the future?”
Shah argues that the answer lies in shifting from perpetual crisis management to long-term sustainability, citing artificial intelligence (AI) as one of the most powerful tools hospitals have to make the leap. “AI is helping leaders move beyond quick fixes. In revenue cycle management alone, it’s strengthening cash flow while cutting out enormous administrative waste.”
Hospitals are using predictive algorithms to flag claims at high risk of denial so errors can be corrected before rework piles up. Automated eligibility checks reduce billing surprises later. Patient cost-estimation tools are helping build financial trust at the front end. On the back end, natural language processing and robotic process automation are taking the grind out of repetitive documentation and billing.
The results are cleaner claims, faster reimbursements, healthier margins—and less burnout for revenue cycle staff. “When you can stabilize revenue cycle performance, you have room to reinvest,” Shah says. “That’s when throughput, workforce resilience and community trust really start to strengthen.”
Shah’s recommendations don’t stop at technology. He points to Johns Hopkins Medicine’s “capacity command center” as a model for balancing immediate pressures with long-term fixes. By managing beds, transfers and discharges in real time while collecting system-wide data, Johns Hopkins was able to improve safety, access and throughput—and recoup its investment quickly. “That’s the kind of enterprise approach hospitals need to escape crisis mode.”
On the ground, every small operational move is adding up. Programs like Cleveland Clinic’s P.A.T.H., which hardwires early-morning discharge bundles and interdisciplinary coordination, have shortened length of stay without compromising safety. “When you align teams around throughput, you’re not just moving patients faster—you’re freeing capacity for better care,” says Shah, who also serves as Chairman of Counterforce Health, which offers NIH-grant funded AI tools that help hospitals with revenue cycle management and patients with denied insurance claims.
Shah says the bigger strategic play is embedding value-based care metrics into service line dashboards. “If you can show that reducing readmissions or length of stay improves both quality and costs, you create alignment between clinical operations and financial performance.”
“When you align teams around throughput, you’re not just moving patients faster—you’re freeing capacity for better care.”
— Neal Shah, CEO, CareYaya Health Technologies
There are opportunities ahead. For example, Shah sees promise in models like “Hospital at Home,” which can free up inpatient beds while lowering mortality and post-discharge spend, and in-health systems expanding into accountable care organizations to capture shared savings. Through it all, sustainability comes back to people. “If you want to thrive under pressure, make cost discipline participatory. That’s how hospitals build trust, resilience, and lasting impact.”
In the end, thriving under pressure is more than cutting costs; it’s about building systems that align financial stability with quality care. By embracing innovation, empowering staff and investing in resilience, hospitals can transform today’s challenges into a foundation for lasting success.
SIDEBAR
5 moves to build hospital resilience
- Use AI in revenue cycle – Predict denials, automate checks and cut waste
- Create a command center – Manage beds, transfers and discharges in real time
- Prioritize early discharges – Free capacity while keeping care safe
- Track value-based metrics – Link quality gains to financial outcomes
- Engage staff in savings – Frontline ideas reduce costs and boost morale
Sources: Kara Brooks, American Hospital Association (AHA); Neal Shah, CareYaya Health Technologies
