As technology advances and care shifts toward outpatient, virtual and community-based settings, the role of the COO is also evolving. For leaders in this position, that means new skill sets and a broader range of focuses, from managing hospital operations to coordinating complex, widely distributed networks of care.
In its 2025 report “Decoding the Healthcare COO Role,” executive search firm WittKieffer found that 80% of healthcare COOs said their responsibilities have increased significantly in the past three years, while 63% reported an increase in the number of direct reports.
The report also found the role expanding across areas such as growth strategy, talent oversight and community engagement. Many COOs now oversee a wide range of operational functions, with ambulatory services and nursing among the most common.
“One of the challenges with the COO role is how big the scope is,” said Timothy Riddell, MD, executive vice president and COO of New Orleans-based Ochsner Health. “Simplifying the strategy so that it can be digestible and actionable, while not losing the complexity or the impact, is critical. The question is how you do both of those things at the same time.”
Becker’s spoke with Dr. Riddell and Steve Burriss, COO of Orlando (Fla.) Health, about how the role is evolving — and what operational leadership looks like as care continues shifting beyond hospital walls.
Access as the central operational challenge
Mr. Burriss and Dr. Riddell both serve in their roles as their respective systems expand access through outpatient care.
Orlando Health added Support Team for Aftercare and Resources outpatient centers and is working to bring more complex specialty care closer to communities, including oncology services that allow patients to receive treatment nearer to home.
The health system and Southlake, Texas-based Solara Surgical Partners also launched a national joint venture in 2025 to expand ASC development and operations. The venture aims to improve existing ASC operations and accelerate the launch of new centers, while also meeting growing demand in the outpatient surgical space.
“We also constantly keep our finger on the pulse of our communities, identifying when we are needed before they become healthcare deserts,” Mr. Burriss said. “Because of this, we are at the ready to bring our trusted expertise, skilled physicians and high-quality systems rapidly and intentionally.”
At Ochsner Health — a system with 47 hospitals and more than 370 health and urgent care centers — access is also viewed through the lens of patient flow across the entire care journey, from emergency departments to primary care follow-up.
The system launched a virtual emergency department in October 2024 to help address persistent overcrowding across its hospitals in Louisiana, Mississippi and Alabama. First-year results showed more than 16,000 patients through that program.
In September, the system also opened a 100,000-square-foot outpatient facility in Lafayette, La., representing a nearly $35 million investment by the organization.
Dr. Riddell, who was appointed executive vice president and COO in January, noted that the concept of access looks different depending on where clinicians sit within the care continuum.
“If I am an RN on the med-surg floor, access for me is whether I got the patient up from the emergency room in a timely fashion and whether I safely discharged them home in an appropriate fashion,” he said. “If I am a primary care doctor in the clinic, access is whether I was available when that patient got out of the hospital to see them quickly, or whether I prevented their hospitalization because I had the ability to get them into my clinic ahead of time.”
The COO role is becoming more connective
With access, care quality and patient experience in mind, there are also newer skill sets needed in the COO role. COOs today must manage financial pressures as well as balancing time across operations, strategy and people; increasing capacity and throughput; aligning operations with strategy; and overseeing complex environments, WittKieffer noted in its report.
To thrive in today’s environment, the firm noted COOs must be successful in terms of leveraging technology and artificial intelligence, maintaining clarity amid chaos, identifying cross-industry patterns and guiding across distributed environments.
“There are key skill sets that are needed across the board,” Dr. Riddell said. “The first is a deep understanding of the complex payer arrangements we deal with. Value-based care continues to be an important part of how we deliver care and how we are reimbursed, but it is not the only part. What that looks like for different patients across different demographics and geographies is something we have to be expert in.”
Additionally, he said COOs must understand not only technologies, but the change management involved in redesigning organizational structures so they work effectively with the new technologies.
“The way we handled access in the past was almost like managing math with a slide rule versus managing it with a computer,” he said. “The complexity is greater now, but there is also more insight and more data because of technological advancements. We have to understand both what is possible and what is aspirational.”
“Showing up really matters,” Mr. Burriss said. “And that rings true for leading a healthcare system too.
“By expanding access to care, we are all across the map from Florida to Puerto Rico and up to Alabama. So I’m definitely traveling more because being present is fundamental. But I can’t be in all places at once. So what is also critically important is tapping into our partnerships and relying on our growing network, like joint ventures with physicians which is a new skill set.”
Mr. Burriss said communication is also crucial as a skill set, adding that the health system uses communication channels to “meet our patients where they are, listen to what they need and then fill those gaps with high-quality care quickly and expeditiously.”
Balancing inpatient and outpatient capacity
For COOs, balancing inpatient capacity with outpatient expansion is vital. For Orlando Health, this means going to markets only where there is opportunity to elevate care for patients who need more access.
“Our focus is filling the gaps where they are needed whether it be with urgent care, freestanding emergency departments, ambulatory care centers, outpatient imaging or inpatient care,” Mr. Burriss said.
Dr. Riddell expressed similar sentiments, noting the importance of bringing ambulatory and inpatient teams together so they work in concert. He said the handoffs “should be less like handoffs and more like continuations of care.”
“I do not think I have a playbook that solves all of that, but that is the playbook we need to start working from,” he said. “It allows us to seamlessly shift sites of care, especially as more inpatient procedures and events can occur in ambulatory settings.”
Navigating the shift
As COOs navigate care delivery shifts and newer skill sets, they said they remain focused on innovation.
“I’m also very intrigued by wearable devices and how we can harness that collected data for preventative healthcare innovations,” Mr. Burriss said.
He said the system is also leveraging IT to provide holistic patient care, including remote monitoring.
“This ensures we care for our patients not only during acute episodes but also help them maintain their health to prevent future episodes,” Mr. Burriss added. “And when it comes to AI — AI holds tremendous promise, and we have to be careful, thoughtful and deliberate about how we utilize it. And we’ve done so in a way where AI assists our team as a tool, not a replacement. That trusted connection between our patients and physicians is paramount.”
As a primary care physician, Dr. Riddell said “the primary care clinic of the future is here.”
“If you think about where primary care clinics have been, they often look similar to how they did 50 years ago,” he said. “Meanwhile, you can walk into an operating room and see robots and advanced technologies.”
He agreed with Mr. Burriss that AI is also a large part of that transformation.
“We are seeing opportunities around notetaking and related pieces, but that is just the tip of the iceberg of the opportunities ahead,” he said.
“If someone is coming into this role and thinking about how to approach it, the key is grounding the work in purpose and understanding how access, quality and experience connect across the entire system.”
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