HCA Healthcare has historically been one of the nation’s most efficient health systems, providing cost-effective care at scale and exhibiting operational excellence. As the care environment shifts to more ambulatory care sites and patient populations become older, HCA Healthcare is adapting to meet patients wherever they are to improve accessibility while maintaining a high standard for safety. And as one of the largest employers in the United States, HCA Healthcare must carry this community focus into its talent strategy to ensure the quality of care is consistently exceptional. The driving force behind that efficiency and adaptability? Self-disruption.
HCA Healthcare strives to constantly improve internal processes, integrate the newest technology, and provide nurses and practitioners with education opportunities throughout their careers. Inside HCA Healthcare’s hospitals, care delivery methods are industrious and dynamic, and across all locations, HCA Healthcare emphasizes geographic-centric care, bringing nuance to care delivery approaches to adapt to rural and urban settings.
In this episode of McKinsey on Healthcare, Senior Partner Drew Ungerman caught up with Sam Hazen, HCA Healthcare’s CEO. They discuss HCA Healthcare’s approach to self-disruption, the technology that will help it carry forth its goals, and the talent strategy the organization is employing to uphold a strong, community-centered workforce.
An edited version of their conversation follows.
Meeting the moment in healthcare
Drew Ungerman: You lead one of the nation’s top networks of hospitals and care sites. What are some of the most important industry shifts you’ve observed over the past few years?
Sam Hazen: We see three factors shaping the industry. First, we’re seeing more ambulatory care. This creates convenience for patients and safer, more cost-effective environments—and it’s good for the system.
The second is increased demand in the rural healthcare market. The rural health transformation package in the Big Beautiful Bill has the potential to help with that, but it’s very important that it supports the market’s development needs.
Last, the acuity of the inpatient population continues to advance. We’re seeing more critical conditions among our patients and more people who have aged into different categories, resulting in a natural lift in the acuity and complexity of the care we have to provide.
Drew Ungerman: Given those important shifts, how do you ensure HCA Healthcare is prepared to meet the moment?
Sam Hazen: To meet the need for ambulatory care, we’re investing heavily in outpatient facility development. On the rural healthcare side, we have numerous initiatives to support patients, including telemedicine and transportation capabilities, and our physicians participate in satellite clinics as appropriate. All these things help people and, hopefully, create more access to care.
From an acuity standpoint, we’re investing in our networks with respect to clinical technology. Each community is different, so we adapt to those circumstances.
Balancing scale with a focus on community
Drew Ungerman: HCA Healthcare operates at a high level of scale and centrality to the communities it serves, which creates unique pressures around consistency, quality, and workforce stability. How do you manage those challenges across such a broad network?
Sam Hazen: One way we leverage our scale is by extending intellectual capital, or best practices, across the company. Our emergency rooms are a classic example: We take care of almost ten million people, and we see a patient within 11 minutes on average—and we’re very disciplined about carrying forward standard operating procedures in our emergency rooms. We’re also getting better at consolidating education. These are iterative things that we’re doing.
Drew Ungerman: As you extend best practices across the organization, how do you harmonize agility and speed with standardization?
Sam Hazen: First, we organize geographically to stay connected to communities. Where is the community growing? Where do we have holes in our network? How can we improve connectivity for patients so it’s easy for them to move around our system? Then we organize at the corporate level in functional ways. For example, we have a corporate medical education capability to ensure compliance, best practice adoption, and faculty performance.
I’m proud of our teams and how they embrace what I call the pace of play—recognizing situations, issues, and opportunities and then advocating appropriately so we can respond in a timely way. Everybody benefits from that.
Drew Ungerman: Speaking of the pace of play, a lot of newer entrants have entered healthcare. How do you think about disruption in the industry?
Sam Hazen: Healthcare is a difficult industry to penetrate, so disruption has to come from the inside; the system has to own its realities and recognize variations in efficiencies. At the same time, we have to look outside the industry to see what others have done. Then we can bring those learnings into the business and create the disruption I want to see in our company.
That’s where McKinsey helps—by providing examples of how other companies have approached talent development, capital allocation, risk management, or the supply chain.
Harnessing the power of technology
Drew Ungerman: I want to shift into technology. Everyone is talking about data and AI. How do you think about building and using those capabilities?
Sam Hazen: Our AI agenda is organized into three domains: administrative, operating, and clinical. We’ve built out programs underneath each of those domains, and we’re implementing them at different paces. Clinical will be a little slower for obvious reasons, but we need to go at pace there, too.
We’re building out this strategy over the next few months in a more comprehensive fashion, and that will allow us to prioritize, allocate resources, and then go to market with speed. We’re also in the process of carrying the lessons that we learn from our system implementations on the clinical side to these other digital solutions to create value.
Drew Ungerman: Once you’ve built out your AI strategy, what are some of the benefits you expect to see?
Sam Hazen: Among other things, AI will give us a better line of sight on what goes on inside our facilities. Our approach is to understand why we have been successful in our clinical system implementation and carry those lessons forward into new digital solutions that can help us change the paradigm.
Automation plays a part in this, and so does educating our workforce and getting them excited about the possibilities. The opportunity to use AI agents to help nurses provide more timely, more effective care to a patient is exciting. I think it’s going to change the game, and we are all in on it.
Drew Ungerman: I couldn’t agree with you more. There are also clinical shortages, and technology can provide an important enabling solution to those challenges. To realize that full potential is a massive change management challenge. How are you thinking about change management in this arena?
Sam Hazen: It requires leadership, first and foremost. Next, it requires a very organized approach to laying out the plan, understanding its strengths and weaknesses, and gathering metrics. And this is where I think our teams are great: They’re connected to the business in real time, which allows us to adjust.
It’s easy for me to say, “Let’s go do this.” But then 315,000 people have to absorb all of that, and that’s not necessarily easy. But again, I go back to our patients, and I go back to the need to disrupt, and we’ve got to find a way to do it at pace and do it effectively. And that’s what we’re working on now.
Leadership that can take HCA Healthcare further
Drew Ungerman: I want to switch to the topic of leadership and talent. How are you thinking about building leadership to meet tomorrow’s challenges?
Sam Hazen: One of our strategies is tapping into what I call our underground talent. We have so many talented people, and we’re investing in executive development and career-changer programs to get them into new progressions. That is a growing component to create the succession planning that we want.
I’m a product of HCA Healthcare’s development program myself. I started here 43 years ago, and I wouldn’t be where I am today if the company hadn’t given me tuition reimbursement. I want others to have the same opportunity, so we are expanding our scope.
Drew Ungerman: How do you build on that early experience with leadership development to continually stay ahead and invest in your own growth?
Sam Hazen: For one thing, I block off at least ten hours on my calendar every week to give myself time to study, analyze our business, or even walk around or make phone calls. That time allows me to slow down, reposition our strategy, and anticipate decisions that we may have to make. As a CEO, you have to have a mindset of wanting to be better, and you have to have a plan for getting better. I want 2026 to be the year of personal and team development for us. I want us to make a step change in our interactions, our effectiveness, and our own capabilities.
Drew Ungerman: As you move into your 44th year in healthcare, looking ahead, what are you most excited about? And what else do you want to do to leave your mark—not just on HCA Healthcare but also on the industry and the country as a whole?
Sam Hazen: AI has energized me to a level that I didn’t expect. I am really excited about what it can do for decision-making and the benefits it will have for people along the way. As I told my team at a recent retreat, “HCA Healthcare has a chance to change the world because of AI and because of who we are—our size, our resources, and our culture.” And that’s what we’re trying to do.
