Stacking aspirations or solving problems

Removing friction from healthcare’s operating model

Healthcare leaders rarely lack ambition. Strategic plans across the industry are filled with bold aspirations, frequently highlighting digital transformation, AI-enabled workflows, new care models, population health strategies, and consumer-focused access. Each initiative promises to improve quality, expand access, and strengthen financial performance.

Yet across the industry, operating margins remain persistently thin. Many health systems operate with margins hovering around one percent or lower. Clinician burnout remains widespread. Administrative costs continue to rise. For many frontline teams, transformation often feels less like progress and more like additional work layered onto already complex systems.

The problem is not a lack of strategy. The problem is organizational friction.

In The Friction Project, Robert Sutton and Huggy Rao describe effective leaders as friction fixers—leaders who design organizations in which the right work flows easily and the wrong behaviors encounter resistance. Their core warning is not against ambition, innovation, or change, but against what they call addition sickness—the tendency of organizations to continually layer new rules, tools, programs, and oversight structures on top of existing work without removing anything that came before.

Importantly, Sutton and Rao do not argue that all friction is bad. In complex systems like healthcare, some friction is essential. Clinical safety checks, thoughtful review processes, and appropriate governance can slow decisions in ways that protect patients and improve judgment. 

The leadership challenge is distinguishing between the friction that protects quality and the friction that merely makes good work harder.

In strategic planning, this tendency toward addition sickness often appears as what I would call stacking aspirations. Leaders engage in bold conversations about digital platforms, AI, and entrepreneurial innovation that are energizing in concept but operationally additive in practice.

As someone who naturally enjoys imagining what comes next, I understand the appeal of these conversations. But aspiration without subtraction can unintentionally create more complexity.

Without a deliberate effort to stop low-value work and simplify existing processes, these aspirational stacks become yet another source of friction for an already strained workforce.

Strategy then becomes something experienced by clinicians and managers not as progress, but as additional reporting requirements, dashboards, meetings, and initiatives competing for limited time and attention.

Solving problems looks different than stacking aspirations.

It focuses on simplifying workflows, eliminating unnecessary approvals, redesigning operational processes, and protecting clinicians' and staff's time. It replaces complexity with clarity and initiative overload with execution discipline.

In that sense, subtraction is not the opposite of strategy; it is one of strategy’s most underused disciplines.

The distinction matters even more in healthcare’s current financial environment. In a high-margin industry, friction is an annoyance. In healthcare—where margins are often measured in tenths of a percent—friction becomes a financial threat.

Recent reporting in Becker’s Hospital Review citing Strata Decision Technology data shows that health system operating margins have remained fragile, hovering around roughly one percent for much of the past year and even dipping negative in early 2026 as labor, pharmaceutical, and supply costs continue to rise.

Friction rarely appears as a line item in a financial statement. But it shows up everywhere in the operating model—in excess labor, avoidable delays, slower patient throughput, revenue cycle rework, duplicated administrative effort, and leadership attention consumed by complexity.

Over time, these inefficiencies accumulate into meaningful costs and lost productivity. In that environment, operational friction begins to function like a hidden tax on margin. Removing it is not merely an efficiency exercise. It is a strategic act.

A simple example of friction in action

Consider a common operational pattern in many hospitals: the delayed discharge.

A patient is medically ready to leave the hospital, but discharge is delayed while care coordination, transportation arrangements, post-acute placement, medication reconciliation, and documentation move through multiple steps and approvals. Each step may be individually reasonable, but together they create a delay.

One additional inpatient day may appear modest on its own. But when this pattern repeats across dozens of patients each week, the cumulative effect is substantial. Beds remain occupied longer than necessary, emergency departments board admitted patients, elective procedures are delayed, and staffing requirements increase to support avoidable inpatient days.

None of these costs appear on the income statement as friction. Yet the economic impact is real. Excess length of stay drives labor cost, constrains throughput, and limits revenue-producing capacity.

What appears operationally as delay often appears financially as margin pressure. Multiply that dynamic across other areas of the operating model, such as documentation burden, prior authorization complexity, revenue cycle rework, fragmented scheduling, and the financial implications of friction, and the picture becomes clear. Small inefficiencies repeated thousands of times quietly erode performance.

The deconstruct phase of moving forward (faster)

If friction is the cost of accumulated complexity, then deconstruction becomes the first discipline of transformation.

Healthcare strategy conversations often begin with questions about what should be built next: new platforms, partnerships, clinical programs, or growth strategies. These conversations are necessary. But they rarely begin with a harder question: What should we stop doing?

This is the deconstruct phase of transformation.