Image by sungmin cho from PixabayHospital and outpatient surgery center leadership has experienced unprecedented turnover in 2025, caused by economic pressures, technological demands and a shifting workforce culture. As CEO and similar departures rise, organizations are adopting new strategies to stabilize teams and maintain continuity.
Through July 2025, hospital CEO exits rose nearly 15% year over year. This occurs even as the overall rate of CEO turnover across industries begins to slow, according to a report from outplacement and career coaching firm, Challenger, Gray & Christmas.
“CEO turnover continues to increase in 2025, showing the immense pressures leaders face in managing economic uncertainty, rapid technological change and shifting organizational priorities,” Andy Challenger, a workplace and labor expert at Challenger, Gray & Christmas, said in the report. “We’re seeing companies adjust leadership faster than ever, with boards demanding adaptability and new perspectives at the very top.”
To fill roles, boards are increasingly turning to interim leaders.
In the first half of 2025, one-third of new CEO appointments were interim, a sharp increase from just 9% in 2024. This trend provides flexibility for organizations facing uncertainty and attracts executives interested in short-term roles.
Turnover rates for key clinical leadership roles in ASCs are not well-defined; however, a 2023 survey by OR Manager found a 35% turnover among registered nurses and a 39% turnover among surgical technicians.
Hospital leadership typically has more infrastructure, which can make it more stable. There are usually well-established support systems, larger teams and clearer succession planning, according to Khaled Nasr, co-founder and chief operations officer at Medely.
Santa Monica, California-based Medely is a business that connects health care providers and workers, both for short- and longer-term positions.
ASC leaders often supervise both the business and clinical aspects of the operation to meet higher and more immediate demands, he said.
“In many ASCs, especially independent ones, leaders are expected to be heavily involved in all aspects, from staffing the facility and working in the operating room to vendor management and ultimately improving the patient experience,” Nasr told ASC News. “We observe that ASCs with stronger workforce support — whether through flexible staffing or smarter scheduling — tend to retain their leaders longer. The ASCs that manage turnover most effectively are the ones investing in leadership development and operational support early on.”
Key drivers for turnover
Medely has noted a rise in leadership turnover over the past few years across both hospitals and ASCs, according to Nasr.
“We’ve observed a shift in the personal expectations that newer leaders are seeking, such as flexibility and a better balance between work and personal life,” Nasr said. “Hospitals are also seeking leaders who may be more technical and capable of making more data-driven decisions in their daily operations.”
ASCs face various pressures, he explained. Administrators have a broader range of responsibilities with less support. ASCs often operate under tighter margins and higher growth expectations, leading to more frequent turnover.
The shift toward outpatient care and consolidation by larger systems and private equity groups has also accelerated leadership changes.
The most common reason cited for hospital CEO departures was stepping down from the role, according to the Challenger, Gray & Christmas report. This often indicates smooth leadership transitions or executives moving into advisory roles.
Retirement is another significant factor. At the same time, some CEOs left for new opportunities or resigned outright.
Financial constraints, rising labor costs, and shortages of drugs and supplies are top concerns for leaders, and hospital boards are under pressure to implement changes to manage slimmer margins and regulatory shifts.
“I think the industry is going through a transition, and you are seeing leaders being asked to do more with less,” Nasr said. “The ones who thrive are finding ways to build resilient teams and lean on technology to ensure they run highly efficient teams and facilities. When leaders have more flexibility and reliable access to staffing resources, it reduces day-to-day pressure and gives them space to lead strategically instead of constantly reacting to shortages – in many cases, that kind of support is the difference between stability and burnout.”
Some industry experts say that although rapid growth is often cited as a cause of turnover, it isn’t necessarily true for all ASCs.
On the administrative side in California, there’s less turnover, according to Karen Reiter, executive director of the California Ambulatory Surgery Association.
“What we’re observing in California is that ASC leadership remains generally stable, and the changes we see are mainly due to industry growth rather than dissatisfaction or turnover,” Reiter told ASC News.
While leadership changes can introduce new ideas and creative opportunities for operational strategies, stability enhances experience and maintains consistency, Reiter said.
“You’ve got both sides of that fence,” she said. “Operational efficiency in surgery centers is being driven by new technology platforms rather than leadership changes. The new platforms are providing layers of data and information that are used to inform the processes at ASCs that achieve greater efficiencies.”
Impact of leadership instability
Frequent leadership changes cause instability, hurt employee morale and disrupt strategic initiatives. Additionally, the continuous cycle of replacing leaders diverts resources and can slow progress.
Replacing a single leader can be expensive. The expense of losing and then replacing a key executive can range from 200% to 400% of that executive’s annual salary, according to findings from the Society for Human Resource Management (SHRM) and the Center for American Progress.
A direct link exists between high turnover, strained resources and adverse patient outcomes. High turnover can impact everything from wait times to communication, as remaining staff take on heavier workloads.
“Leadership stability has a major effect on both performance and patient care,” Nasr explained. “When administrators stay in their roles long enough to build strong teams and improve their facilities’ workflows, you see it reflected in staff engagement and retention, patient satisfaction and overall efficiency.”
Frequent leadership changes may cause a ripple effect. Staff confidence declines, and the facility’s operational consistency is affected. Even small gaps in leadership can delay decision-making and decrease throughput.
“We’ve seen that ASCs with steady, long-term leadership tend to have smoother scheduling workflows, which leads to lower burnout among clinical staff and better financial performance,” Nasr said. “Ultimately, this directly affects patient outcomes and the overall culture of the facility.”
Working toward retention
The widespread health care workforce shortage has made retention a top priority everywhere.
ASCs need to hire the right people, orient them effectively and treat them appropriately to support effective operations and retention, Reiter explained. That should be driven from the top down.
“All our centers are focused on improving onboarding and orientation to prevent early turnover,” she said. “It’s expensive to hire someone. Reinforcing the sense of team connection and belonging and respecting work-life balance, especially in listening to workforce preferences and recognizing generational differences in expectations, is paramount.”
To enhance retention, more ASCs are investing in leadership development by offering mentoring opportunities and providing continuous education in areas such as business management or operations.
Some facilities use technology to reduce administrative work. Tasks like scheduling, credentialing and reporting are becoming automated, enabling leaders to focus more on strategy and staff development.
“Like any other business, we’re seeing a focus on culture where leaders want to feel supported,” Nasr said. “Organizations that encourage collaboration, transparency and flexibility tend to keep their top talent longer. The mindset is changing from ‘replace and recruit’ to ‘develop and retain.’”
But the main challenge right now is finding the right balance between growth and sustainability.
ASCs are rapidly growing as more procedures move from hospitals to outpatient centers. Staffing shortages, payer pressures and operational complexity pose challenges. Leaders must drive growth while maintaining quality and efficiency.
There is a significant opportunity for ASCs to redefine what efficient, patient-centered care looks like, according to Nasr. Leaders who adopt technology, use data to inform decisions and foster strong internal cultures can gain a competitive edge.
“In the end, it’s not about replacing people,” he explained. “It’s about freeing up time and energy so leaders can do what they do best – leading and supporting the best patient outcomes.”
