2026 Healthcare Trends Pt. 2: Relationships, Engagement and Transformation

How do leaders of rural and community hospitals engage with their communities and employees to reset on who they are, how they serve and the value they bring?

Community, public and rural hospitals enter 2026 at a real crossroads: Intensifying financial pressures and declining community trust are converging. Leaders can’t wait for conditions to stabilize—they need the courage to proactively reset relationships with both employees and the community.

That begins with responsible transparency. Many hospitals face criticism not because decisions are wrong, but because the rationale isn’t communicated clearly. With Medicaid cuts, HR1 implications, service reductions and physician turnover all in play, leaders must explain why tough choices are necessary and engage community influencers early—before rumors fill the void.

Hospitals should pair this with structured community perception surveys to understand reputation gaps and track improvement, and consistent employee communication to reconnect the workforce to mission and direction. Staff and community members become advocates when they feel informed and valued.

In a polarized environment, courage means owning the narrative, openly addressing hard realities and demonstrating how the hospital continues to create meaningful community benefit.

When leaders proactively reset expectations, communicate with clarity and demonstrate humility, communities often respond with renewed trust. In the current environment, rebuilding that trust is not optional—it is the prerequisite for long-term sustainability.

What are the key decisions public, community and rural hospitals will have to make this year?

This year will require hospitals—especially rural and community organizations—to make decisions they’ve postponed for too long. Those include:

• Which services to transform or discontinue. With shrinking reimbursement and rising costs, organizations must reassess service-line viability early in the year.
• Which transformation initiatives to accelerate. Incremental fixes won’t be enough; hospitals need to commit to care model redesign, workforce changes, and new partnership strategies.
• How to formalize community engagement as a core capability. Trust-building—through surveys, communication, and outreach—will directly impact the success of any strategic change.

Across all of these, courage is required: each choice carries risk, but inaction carries far greater consequence in 2026’s environment.

With the social and political landscape what it is today, healthcare orgs can’t just be highlighting the medical care they deliver but also who they are and how they show up – both in the community and with their teams. It’s easy to default to focusing on the numbers, but how should healthcare leaders use “softer”, more qualitative measures of how an organization shows up in order to build trust both internally and externally?

In today’s social and political environment, healthcare organizations are being evaluated less like utilities and more like civic institutions. Clinical outcomes and financial performance are table stakes. Trust—internally and externally—is increasingly built on transparency, consistency and authenticity. The risk for leaders is defaulting to scorecards when stakeholders are looking for signals of values in action. 

If I were a leader of a healthcare provider, I would intentionally elevate qualitative measures that answer these three questions:

• Do patients feel seen and heard here?
• Does the patient experience match our stated values – especially under pressure (e.g., workforce shortages, social issues, etc.)
• Is leadership visible, human and accountable?

We’ve seen time and again that trust grows when leaders articulate how decisions are made and not just what decisions are made. Now, more than ever, patients, consumers, Gen Zers are looking for leaders who are human, honest, connected, transparent and visible . And not just during the monthly town hall.

Bottom line: Treat culture, trust and community presence as a strategic assets, not “soft stuff”.

What are the key decisions regional health systems will have to make this year?

Regional health systems are entering a year defined less by growth ambition and more by strategic clarity. The defining question isn’t “How big can we be?” but “Where do we add differentiated value—and where don’t we?”

Along that arc, some additional questions include:

• How aggressive should systems be about exiting, partnering or redesigning areas of their organization, particularly those who are underperforming
• What are we willing to change structurally versus asking our employees to endure?
• Where does advocacy stop and operational responsibility begin?

In crowded markets, trust may become one of the few durable advantages. Regional health systems will need to decide whether they’re willing to invest time, capital and reputation in long-term trust building versus short-term optimization. Hint: It’s an AND not an OR.

We look at box-checking exercises like the 990 and COPA. Providers always have a ton of pressure just to stay compliant. What are some manageable ways for healthcare organizations to go a step further than just checking the compliance box and really advancing their mission through these types of initiatives?

Compliance tasks like form 990 filings, community benefit reports and COPA disclosures are often viewed as liabilities or administrative burdens. But systems that view these reports instead as opportunities to tell a compelling story about their mission and impact, they unlock new platforms for building trust. How to make the most of these opportunities?

1) Publish compliance-related data in accessible, human terms. When stakeholders see openness and clarity, trust grows both inside and outside the organization.

2) Create clear linkages between compliance metrics and broader organizational goals. For example, link COPA commitments to measurable community health outcomes and drive the message home with a compelling patient story.

3) Take this show on the road – don’t let your story live and die in a PDF. Create a “mission in action” roadshow and present your content internally in town halls, leader rounds and digital briefings. Then take your story to the masses by presenting to community partners, civic clubs and policymakers. The more mediums you activate to tell your story, the more impact it will have.

What are the key decisions national health systems will have to make this year?

Reimbursement uncertainties and inflationary cost pressures create a squeeze on margins that even the largest, most successful health systems will feel acutely. Leaders in these systems must determine:

• Where to pursue new revenue streams (e.g., value-based contracts)
• How to reduce waste without reducing access or quality
• What services to scale or de-implement in a resource constrained environment.

At the same time, the rise of AI, digital care models and data-driven operations is repositioning what success looks like. But savvy leaders know that adopting innovation without clear strategy risks wasted investment or clinician burnout. Leaders must decide where to invest deeply versus where to pilot and learn. Aligning these investments with mission and impact — not just innovation for innovation’s sake — is essential.

In a moment where traditional providers are under more pressure than ever, what is the role of and opportunity for health services organizations to grow and further support healthcare for all?

We’ve seen before that when the pressure dial is turned up, the healthcare industry moves a bit faster and is more open to adopting new ideas because it simply must adapt to the changing environment. Our clients in the healthcare services and technology space are primed for this moment. So many of the larger platforms and networks of healthcare services were started because a physician said, “I think there’s a better way to do this,” and made it happen. I believe these organizations are ready to lead the way forward and work with their health system cousins to forge new partnerships, bring innovations that reduce costs to bear, improve patient experience and drive higher quality. This is what they were made for!

What are the key decisions non-acute providers need to be making this year?

As I write this just before the new year, the morning headlines said,“ACA subsidies face imminent lapse.” (Update: Of course we’re on the other side of that lapse, now.) A key decision for non-acute providers who often provide dialysis, retina injections, physical therapy, dentistry, behavioral health, more – will be “What do we do to ensure our patients get the best possible care that they can afford?” That may mean setting up new services, call centers or apps that help patients understand their available care options and finding solutions they can afford.

Additionally, non-acute care providers also will continue to make decisions around infusing AI into their care model and platform, how to attract and retain physicians, nurses and other healthcare talent and consider opportunities to increase scale or drive efficiencies through M&A – just to name a few!

Change fatigue has been an issue for a long time. Yet healthcare leaders are facing maybe more necessary change than ever at a time when skepticism and fatigue is incredibly high. What are the questions leaders need to ask and conversations they need to have to get through these crossroads decisions with everyone on board?

Let’s look at it in three ways.

Seek to understand the story underneath the exhaustion. Before prescribing more change, pause long enough to listen. Ask:

• Which initiatives are most closely tied to the fatigue people are naming—and which caused the deepest disruption or loss?
• Have we truly assessed both the real and perceived returns on past changes?
• Do those most affected believe the juice was worth the squeeze? If not, why?
• And looking back, did people feel prepared for the impact, or simply expected to absorb it?

Understanding what would have helped them feel more equipped then is essential to deciding what’s possible now.

Build a central intelligence portfolio for all change initiatives to provide a single, integrated view of all past, ongoing and future change endeavors within your organization. In the absence of Project Management Offices or Strategic Transformation Offices, we need to ask our organizations: What’s the plan for managing and governing our change knowledge and intelligence for our organization? This isn’t bureaucracy; it’s clarity. A unified view helps leaders see where change aligns with strategy—and where it unintentionally compounds strain. Quantifying the volume and velocity of change makes the invisible visible: capacity, saturation, and risk. Just as importantly, this data either confirms or challenges the prevailing narrative. It gives leaders evidence beneath the story, not just anecdotes above it.

Learn and leverage what energizes those most affected by the change. If fatigue is the problem, energy is the lever. Leaders should understand which improvements people are most eager to see—and why. What feels meaningful, hopeful or overdue? How do those energizing efforts connect to, depend on, or redeem changes that caused the most pain? Progress feels lighter when people can see how today’s discomfort enables tomorrow’s gains.

How do leaders help themselves in this moment? How do they minimize their own change fatigue?

Celebrate and elevate the wins, particularly changes executed successfully, big and small. Momentum thrives on recognition. Celebrating progress reinforces what’s working, surfaces best practices, and reminds teams what they’re capable of—even in relentless conditions. Appreciation isn’t a distraction from hard work; it’s fuel for it.

Leading change requires humility, vulnerability, stability and agility but none of these are possible without strengthening your change leadership capability. Change leadership isn’t instinct—it’s a discipline. Treat it as a core competency and a shared expectation. Invest in development. Partner across functions. Distribute ownership. The burden of change should never rest on one role or one leader alone.

Don’t skimp on strategic change readiness intelligence, change management resources, communications and leadership development. Empowerment, enablement and execution all require investment. Just as critical, leaders must champion—and model—self-care, psychological safety, and balance. In environments of constant change, readiness often depends on recovery. Rest is not resistance; it’s a requirement. Ignoring that reality doesn’t accelerate change—it undermines it.

Everyone is worried about finances and the economy. How should healthcare organizations go about talking about money and how it serves their mission without being tone deaf?

When thinking about philanthropy, it’s important to assert the tangible impact of private support—yesterday, today and tomorrow. We are encouraging organizations to make this point for philanthropic support at all levels, from modest gifts to those in the eight or nine-figure range.

It’s also important to talk about how the combination of public institutions and private funding has long been essential to how we’ve accomplished big health goals and moonshot medical discoveries.

There are major gifts and general gifts. Based on policy, or social dynamics or the economy or anything else, are you tracking any changes in who is giving today and what that means for philanthropic campaigns over the next year or two?

Lots of organizations are tracking these changes—Giving USA, Bank of America/Lilly School survey, etc. For the past several years, growth has unequivocally been at the top, in the eight, nine and 10-figure gifts. One challenge, but also opportunity, is for healthcare organizations to maintain focus on those transformational-level gifts while also building at more modest levels and nurturing relationships over many years. For example, grateful patient programs and “leadership” annual giving programs are key to ensuring organizations are building their prospective donors for the future.

Also—non-patient support for scientific discovery. How are organizations thinking beyond their base of known donors and prospective donors to reach and nurture individuals and foundations that could be significant investors in their research? This is about mapping relationships with board members and others.

 

“Innovation” is an overused term. Still, we’re in a moment where creativity is needed to lower costs and close gaps. Are there any ideas/projects/examples payers are undertaking that could really change the way we think about healthcare?

Finding innovative ways to reduce administrative burden, contain costs and rebuild trust in the system is key for payers. Many payers are starting to leverage AI to help modernize current processes, whether that’s to automate claims or prior authorization. Plans are also looking for responsible ways to leverage AI to improve the member experience. For example by quickly triaging and responding to member inquires or helping health plans quickly identify high-risk members or members at risk of missing care.

How do payers build trust among their key stakeholders, particularly employers and members? What are the elements of trust here?  

It’s no surprise that health insurance is complicated. There are a lot of technical terms and policies and processes to follow. One way to build trust is for payers to re-examine how they’re speaking to their members. Be responsive and empathetic when interacting with members. Be transparent. Clearly and proactively communicate, free of jargon, what is driving costs and policy changes so it doesn’t appear like an arbitrary decision. 

Health plans should consider conducting member research in local markets to better understand the drivers of trust and the sources of value members associate with their health insurance provider. Findings from this type of local research have revealed that while many payers make meaningful investments in the communities they serve through nonprofit funding, employee volunteerism and free or low-cost health programs and services, members are often unaware of these efforts. Proactively elevating awareness of community impact among members and employers can significantly strengthen payer reputation and trust.

AI has sucked most of the oxygen out of the health technology room. What else has been happening over the past year, and what does that tell us about the relationship between the very human, personal side of healthcare and the tech that supports it? 

While AI has dominated headlines, our work this year has consistently emphasized that technology in healthcare is not just about the tools – it’s about how those tools are integrated to support people, relationships and outcomes. At Jarrard, we’ve led efforts to move AI from “shiny object” status to foundational infrastructure, focusing on practical, responsible adoption and ensuring that technology augments, rather than replaces, the human touch.

What are the key decisions healthcare execs will be making about technology – whether integrating remote patient monitoring or implementing more AI – in the coming year?

A few things come to mind.

• Scale What Works. Move from isolated AI and digital health pilots to integrated platforms that deliver measurable ROI, streamline workflows and become part of the organization’s core infrastructure.
• Build Trust and Responsible Governance. Establish clear guidelines for responsible AI use, focusing on transparency, explainability and ethical frameworks. Prioritize data quality and interoperability to avoid new silos and build trust among clinicians, patients, and regulators.
• Keep Technology Human-Centered: Ensure technology adoption enhances clinician and patient experience, addresses change fatigue and supports – not overwhelms – providers and patients. Invest in training and upskilling staff for an AI-enabled future.
• Lastly — consider the plight of the em dash. What was once a powerful piece of punctuation that could sit at the table with the period, comma and exclamation point — in 2025 the em dash was banished to the broom closet. 2026 will signal its triumphant comeback — reminding us that clarity, connection and a well-placed pause are as vital in communication as they are in healthcare transformation.

Children’s hospitals enjoy massive trust from the American public. When thinking about the current challenges in healthcare, particularly misinformation, cost/loss of coverage and the resultant decline in preventive care, should children’s hospitals use that trust to drive broader positive perception of healthcare?

I don’t think children’s hospitals are in a position to change the direction of the country’s overall declining trust in healthcare as a whole. However, with 79% of the public saying they trust children’s hospitals with the care of kids in their community – a percentage higher than any other healthcare segment we study – there is an opportunity to serve as a strong voice and advocate for the many issues that directly affect kids. Those include Medicaid, vaccines, mental health and overall access to care. Of course many of those issues are also critical to the entire healthcare delivery system. In that way, the effective advocacy of children’s hospitals can advance larger goals.

What key decisions are children’s hospitals facing in 2026?

To be clear, the federal government is not likely to rescue children’s hospitals – or any other hospitals – from headwinds like Medicaid cuts, research funding declines and erosion of longstanding scientific principles. What children’s hospitals can decide to do is to look at how they serve their local and regional communities in ways that inspire private investment as well as trust in their expertise. To do so requires deep understanding of your local environment and tailoring both communication and strategy to the needs of the kids closest to home.