When a Leader Leaves: Why Healthcare Is Turning to Interim Executives
When a COO, CNO, or revenue cycle leader leaves a healthcare organization, decisions stall and teams get nervous. The work that keeps patients safe and the lights on starts to slip.
The old approach was to wait it out: post the job, run a long search, and ask everyone else to cover. More healthcare organizations now see that as a risk they can't afford. They're bringing in interim executives, experienced leaders who step in quickly, stabilize the operation, and keep strategic work moving while the right permanent hire is found.
Leadership turnover is accelerating
Through the first half of 2025, hospitals recorded 68 CEO exits, up 3% from the same period the year before, according to Challenger, Gray & Christmas.¹ By July the count had reached 78, a 15% increase over the prior year.²
Reliance on interim leaders was one of the most notable CEO turnover trends of 2025.¹ Challenging conditions are pushing long-tenured leaders to retire or step aside, and boards are using interim leadership to bridge the uncertainty.¹
The CEO seat is only part of it. When a top leader departs, others often follow, and every vacancy puts pressure on the people left behind.
As ACHE's Deborah Bowen put it, "the value of strong and capable leaders in healthcare has never been more important."³
Six interim roles and when each makes sense
Interim COO
The COO keeps the entire operation running: staffing, throughput, service lines, facilities, and the systems that connect them. When that seat is empty, operational problems pile up and the CEO gets pulled into the weeds.
An interim COO restores operational stability and keeps major initiatives on track, which frees senior leadership to focus on strategy.
Best fit: Leadership transitions, mergers and integrations, new facility openings, or organizations facing an operational or financial turnaround.
Interim CNO
Nursing leadership is one of the most critical seats in any hospital, and one of the most vulnerable. In AONL's latest research, leaders with CNO titles had the highest turnover intent of any nursing leadership role, at 12%, and around half of nurse leaders named staffing as their single biggest challenge.⁴
Nurses feel a CNO departure first. An experienced interim steadies the nursing team, protects quality and safety, maintains regulatory readiness, and keeps recruitment and retention efforts moving.
Best fit: Unexpected CNO departures, survey or Magnet preparation, units with high turnover, or organizations rebuilding nursing culture.
Interim CFO
Healthcare finance doesn't pause for a search. Budgets, payer negotiations, audits, cost reporting, and board reporting all keep moving. An interim CFO provides steady financial leadership, protects cash flow, and gives the board confidence during the transition.
Best fit: Financial turnarounds, mergers or affiliations, audit or reporting challenges, and CFO departures during budget season.
Interim practice administrator
Physician practices and clinics run on strong administrators, who handle everything from staffing and scheduling to billing, compliance, and patient experience. Demand for them is climbing: the BLS projects employment of medical and health services managers will grow 23% from 2024 to 2034, much faster than average, with a median annual wage of $117,960 in May 2024.⁵
With that much competition for talent, finding the right permanent administrator takes time. An interim keeps the practice running, keeps physicians focused on patients, and catches small problems before they get expensive.
Best fit: Administrator departures, practice acquisitions or integrations, rapid growth, and practices with billing, staffing, or operational challenges.
Interim revenue cycle leader
Revenue cycle is where a leadership gap costs real money, fast. In Experian Health's 2025 State of Claims survey, 41% of providers reported claim denial rates of 10% or higher, a figure that has grown every year since the survey began in 2022.⁶ Some 54% say claim errors are increasing, 68% say submitting clean claims is harder than a year ago, and 43% report being understaffed.⁶
Without strong revenue cycle leadership, denials grow, cash slows, and staff spend more time reworking claims. An interim leader can diagnose the problem, stabilize collections, and put the right processes and technology in place.
Best fit: Rising denials or A/R days, system conversions, post-merger integration, and organizations without a dedicated revenue cycle leader.
Interim clinical operations leader
Clinical operations leaders connect patient care to the business through patient flow, care coordination, quality programs, and departmental performance. When the role is vacant, efficiency and patient experience both suffer.
An interim keeps departments aligned, maintains quality metrics, and can lead specific projects like reducing wait times or improving throughput.
Best fit: New service lines, quality or throughput improvement initiatives, EHR implementations, and leadership gaps in high-volume departments.
When interim leadership makes sense
It's usually the right move when:
A leader leaves unexpectedly. An interim keeps a vacancy from becoming a crisis, so you can run a careful search instead of a rushed one.
You're in the middle of change. Mergers, affiliations, system conversions, and turnarounds need experienced leadership now, not in six months.
You need specialized expertise for a defined period. A revenue cycle turnaround or survey preparation may call for a seasoned expert for months, not permanently.
You want to get the permanent hire right. An interim gives you time to work out what the role truly needs, and sometimes the interim turns out to be the right permanent fit.
Your team needs stability. Leadership gaps hurt morale, and a steady interim tells staff the organization is in good hands.
Stability is a strategy
The strongest healthcare organizations plan for a leadership gap before one happens. They know which seats are most critical, which leaders may be nearing retirement, and who they'd call if a key role opened tomorrow. Interim leadership belongs in that plan from the start.
"In healthcare, you can't afford to leave a critical leadership seat empty while you search. Interim leaders bring stability to teams that need it most, so you can protect your patients, your people and your margins while you find the right long-term fit." Amy Knox, CEO / Co-Founder, Nmble Medical
Let's keep your organization moving
At Nmble Medical, we help healthcare organizations find experienced leaders who can step in quickly, whether you need an interim CNO next week, a revenue cycle expert for a turnaround, or a permanent executive.
Let's talk about where your leadership team needs support.
What got fixed
Opening: "A leadership gap is never just an empty office" is a setup-then-reveal line, and the three-part list after it ("decisions stall, teams feel uncertain, and the work... starts to slip") was padded. Now it's two plain consequences.
"Leadership changes are coming faster." It repeated the heading and added nothing. Cut, and the stat leads.
"Interim leadership has become an essential part of that plan, not a last resort." This is the "not X, it's Y" move, and it also restated the section. Now it makes one point and stops.
Role descriptions: Several ran on the same three-verb pattern ("restores, keeps, and frees"). I cut the COO, practice administrator, and clinical operations ones to two items so they don't all sound alike.
Filler transitions: "And demand is rising fast" and "With demand that high" were softened or replaced. The second one also made a leap (high demand for administrators doesn't by itself mean hiring takes time), so I reworded it as competition for talent.
Stock phrases: "lead with confidence" and "your next chapter" are gone from the close.
Dashes: I kept the quote as written and added none.