Operational grip: A missing link for health system sustainability

Hospitals in Canada are operating in one of the most challenging environments in recent memory. This article summarizes research conducted by Tectonic Advisory Services on what Canadian healthcare leaders are experiencing and what capabilities they believe they need to operate sustainably in the current environment. It also shares GE HealthCare’s model for health system operational maturity, what that looks like in practice and how a real-time and predictive operational control system can help hospitals manage pressure.

Early in 2026, Tectonic Advisory Services held more than 30 discussions with hospital CEOs, CFOs, CIOs, and clinical, operational and digital leaders about healthcare sustainability in today’s operating environment, and obtained perspectives from Ontario Health, the OHA and others as well. Several themes emerged from the work that suggest leaders are shifting their thinking.

Interviewees shared a common view of the current challenges. Funding has not kept pace with inflation, population growth, aging demographics or changing care delivery models. Gaps in workforce, primary care and long-term care capacity and capital investment add strain on the system. Most organizations have stripped overhead and exhausted traditional efficiency initiatives, while demand continues to outpace capacity and prolonged “surge” conditions are the norm. Leaders view this current environment as their new operating reality, not as a near-term budgeting challenge. The question is no longer simply what other efficiency and cost-cutting measures can we take, but rather what capabilities do we develop to foresee operational pressures early and optimize how we use available capacity and resources accordingly.

A New Operating Model for a New Reality: Interviewees consistently described a desired future state in which operational pressure is predicted and proactively managed, rather than responded to after it becomes a crisis. Leaders want a system wide view of emerging capacity constraints and the actions they can take immediately to eliminate the pressure. For example, continuously identifying patients who are likely ready to transition out of ICU can help reduce ICU capacity pressure, reduce excess patient days, preserve ICU access for higher-acuity patients and improve enterprise patient flow.

Interviewees also emphasized the importance of consistent execution and moving away from manual, reactive processes and local vigilance for ensuring on-time completion of critical path activities, escalations, and surge capacity activation and deactivation. Disciplined execution is increasingly being seen as a requirement for operational success rather than an administrative function. Health systems that incorporate accurate estimated discharge dates into daily flow decisions instead of just documenting and reporting statistics on it are one such example.

Perhaps most importantly, interviewees expressed an urgent need to enable organizations across the care continuum to more easily share information, coordinate decisions and collectively manage capacity and flow. They are acutely aware that many hospital capacity challenges extend beyond the hospital walls with delays involving home care, long-term care, rehabilitation, mental health, diagnostics, transportation, emergency medical services and transfers.

The common theme that emerged is health systems have a near-term opportunity to create more predictable and sustainable operations through stronger operational grip. This is an organization’s ability to consistently execute on its strategy through its daily operations. It requires a system-level mindset, trusted information, standard work, clear roles and decision rights, escalation mechanisms, strong governance and accountability, and technology to connect the dots between these components and between teams.

From Digital Maturity to Operational Maturity: Over the past decade, hospitals have invested heavily in digital transformation. Electronic health records, analytics platforms, workflow tools, dashboards and increasingly AI insights have improved access to information. Yet, a common challenge has emerged across these digitally mature organizations. While information is abundant and dashboards are plentiful, throughput delays, transfer bottlenecks, capacity constraints, manual work and execution gaps persist.

GE HealthCare’s decade-long command center experience has shown that purpose-built care orchestration software can support significant improvement in capacity utilization and patient flow performance, even in digitally mature hospitals that have invested heavily in EMRs and business intelligence tools. Across implementations, the improvements have typically been accompanied by teams working in sync across departments, more consistent execution of high-priority workflows, and shorter patient wait times and lengths of stay.

This has led some health systems to focus on achieving what GE HealthCare describes as operational maturity. Unlike digital maturity, which emphasizes information availability and workflow digitization, operational maturity emphasizes dynamic, coordinated and proactive execution of operational processes. It establishes operational grip by aligning teams around common priorities, clarifying decision rights, standardizing escalation processes, load balancing demand across the enterprise and ensuring actions occur consistently and at the right time. For leaders, this distinction is significant. Digital maturity improves visibility. Operational maturity improves execution. Sustainable performance needs both.

The Financial Imperative: GE HealthCare and Tectonic have heard from CFOs their priorities include reducing the operation of unfunded beds, reducing the spend on overtime and agency staffing, and avoiding costly crisis management practices. CFOs emphasized that greater discipline with how funded capacity and resources are managed, especially in a post-Covid world, could help eliminate avoidable inpatient days, reduce overcapacity days, and ultimately mitigate the financial pressures contributing to hospital deficits. They also recognized that even though incremental funding associated with higher patient volumes can lag behind the costs, volume growth is important to preserve access to care, and should be accommodated in funded bed capacity wherever possible.

Interviewees also highlighted broader strategic benefits. Stronger operational grip could potentially help delay or avoid major infrastructure investments, accelerate the scaling of acute-care-at-home and other models of care that reduce unnecessary inpatient days and admissions, and support more coordinated use of resources between facilities.

Interest in systems like GE HealthCare’s command centres that help reduce operational volatility and support more predictable use of resources is growing. Investment in these capabilities is increasingly being viewed as foundational operational infrastructure, not as discretionary technology projects.

Conclusion: The era of large-scale digital transformation is maturing. Information is more accessible and workflows are more standardized. The findings from Tectonic Advisory Services’ research, together with GE HealthCare’s command centre experience, suggest that managing with better operational grip may be the next major lever to significantly improve patient access, strengthen workforce sustainability, protect financial performance and deliver better care within existing funded capacity.