Why Healthcare Leadership Is Harder Than Ever: Cedars-Sinai’s Tom Priselac on Culture, Change and Cost

Cedars-Sinai has evolved from a community hospital to a major academic health system with an international reputation for quality care, community service, research and education. Much of that evolution and expansion took place under the leadership of Tom Priselac, who served as President and CEO for 30 years, until his retirement in 2024.

After joining Cedars-Sinai in 1979, Priselac spent nearly half a century at the organization, rising through a series of leadership roles as the institution expanded its academic mission, built an integrated medical network and adapted to major shifts in healthcare delivery. That long tenure gave him a rare vantage point on how health systems change over time, and what it takes to lead through multiple eras of disruption.

In this episode of Healthcare is Hard, Priselac reflects on why the leadership job in healthcare feels more challenging now than ever. The pace of change is faster, and today’s leaders are navigating a far more complicated environment shaped by financial pressures, regulatory demands, rapid technological advancement and major scientific breakthroughs. But even with all that complexity, Priselac argues that the fundamentals of leadership remain the same. He advocates for creating a culture of excellence, helping people understand why change is necessary, and making sure an organization can absorb change in a thoughtful way.

Some of the topics Tom and Keith discussed include:

• Culture at the heart of healthcare. Priselac returns repeatedly to the importance of values, emotional intelligence and culture in healthcare leadership. In his view, an organization’s culture reflects the decisions, behaviors and priorities of its leaders, and that matters even more in complex environments like academic medical centers. Whether the challenge is aligning faculty, community physicians, researchers or administrators, success depends on keeping patient care at the center and building a shared sense of mission.
• Pushing change too fast. One of Priselac’s clearest leadership lessons is that organizations and people can absorb only so much change at once. While today’s leaders face real pressure to move more quickly, he warns that some of the biggest mistakes happen when executives short-circuit the change management process. Looking back on his own career, he says some of his most important learning came from moments when he pushed for too much change too quickly.
• Why cost and access still keep him up at night. Even with all the promise of genomics, proteomics, cell and gene therapy, and AI, Priselac remains deeply concerned that healthcare’s affordability and access problems are worsening faster than policymakers are addressing them. He points to clear signs of strain already in the system – communities losing access to care, hospitals in urban areas operating beyond capacity, and patients spending hours waiting for admission. For all the excitement around innovation, he sees cost and access as the country’s most urgent unresolved healthcare challenges.

To hear Keith and Tom discuss these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.