With an aging population and workforce, shifting work expectations and preferences, rapid technological evolution, and regulatory changes in how healthcare and research are financed and conducted, boards are facing heightened levels of uncertainty and disruption.
The COVID-19 pandemic put the workforce at the forefront of our ability to accomplish other strategic goals, from finance and operations to safety excellence. Yet opportunities remain for boards to more fully integrate and leverage human resource expertise to differentiate the organization and create a future-ready workforce.
The American College of Healthcare Executives conducted a 2025 qualitative research study that involved in-depth interviews with 26 chief human resources officers and CEOs to identify key themes relating to how organizations are evolving the role of the CHRO and the future of work. Here are key findings from this research, with implications for healthcare boards.
Elevating the CHRO Partnership
Nearly 70 percent of public companies report enhanced CHRO involvement in board activities over the past three years, with 39 percent of CHROs now attending every board meeting. In healthcare specifically, 90 percent of CHROs report directly to the CEO.
However, this elevated role brings new challenges. Thirty-nine percent of CHROs wish they had better preparation for working with boards. This creates an opportunity for boards to be proactive in creating an environment where HR expertise is both encouraged and expected in decision making, with the recognition that board relations may be a growing area of expertise.
The scope of modern CHRO responsibilities has expanded dramatically. Only 15 percent of CHROs now spend most of their time on traditional people-related issues, with the majority focusing on business strategy and organizational transformation. These executives face a 23 percent increase in unique skills requirements—more than any other C-suite role analyzed—while managing competing demands for aggressive growth targets alongside significant cost reductions.
High-performing CHROs demonstrate 2.3 times more advanced proficiency in systems thinking, financial acumen, and business expertise combined. Given the increasing demands and strategic importance of the role, boards should ensure the senior-most HR executive has enterprise-level visibility and support.
CHRO Involvement: Wider and Sooner
When CHROs are invited as regular participants in board activities, their involvement is often limited to compensation and benefits discussions and committees. Even in organizations that involve CHROs in the strategic process, their engagement sometimes begins after key decisions have been made.
For example, if a board approves the expansion and investment in a new surgical tower, the CHRO is involved only once plans are already underway for staffing projections and recruitment needs.
This represents a missed opportunity for incorporating human capital strategy into the fabric of strategic decision making. It can result in unrealistic workforce and recruitment goals, as well as miscalculations regarding the feasibility and timeline for achieving full staffing, which can impact financial projections and the risk analysis of committing capital.
Committing Resources to Workforce Development
Given prolonged national talent shortages and waning success in recruiting sufficient staff, many organizations are making a hard pivot to growing talent from within. This involves robust talent development programs, reskilling and upskilling efforts, and internal and external pipeline development.
CHROs are recognizing that to develop a talent pipeline to meet future needs, they will have to get people into the organizational ecosystem much sooner. They are also focused on attracting people to the healthcare industry altogether to combat competition from manufacturing and retail.
These efforts are starting sooner, with organizations proactively reaching into middle schools to foster interest and partnering with universities and technical schools. Trends were also noted in a less prepared workforce requiring more on-the-job training.
Boards will need to balance accountability on annual or quarterly timelines with the recognition that investments take time to come to fruition. Boards can also support these efforts by using their connections and influence to advocate for flexibility in clinical roles, career pathways, and scope of practice—creating new avenues to address workforce shortages—and by making connections to potential community partners.
AI Governance and the CHRO's Central Role
AI promises substantial benefits, with potential cost savings of $60–$120 billion over five years for hospitals through enhanced diagnosis support, administrative automation and virtual training programs. Realizing these benefits requires sophisticated governance structures that balance innovation with safety, ethics and compliance requirements.
AI will likely have a profound impact on the workforce, with the potential to augment, replace, or reimagine roles. CHROs are focused on shifting from a jobs-based architecture to a skills-based architecture, which is particularly challenging given historic rigidity and regulations around tasks and disciplines.
The senior HR executive must be a central figure in the governance structure overseeing AI decision making. They have unique insight into the impact on the workforce and can balance interest in financial and operational gains with the impact on human capital strategy and culture.
Healthcare’s workforce challenges affect entire communities, making board governance decisions matters of public responsibility. Boards that fully embrace the strategic importance of HR expertise position their organizations for success in an environment where human capital strategy is central to performance in every area.
TGI thanks Katherine A. Meese, PhD, CEO, HuMargin Group, and Deborah J. Bowen, FACHE, CAE, president/CEO of American College of Healthcare Executives, for contributing this article.
Editor’s note: This content is excerpted from an article in the December 2025 issue of BoardRoom Press, The Governance Institute’s bimonthly magazine. Visit the BoardRoom Press webpage (Governance Institute member login required) to access the full article.