Transformational leadership in health care: A case study of Cone Health’s US$100m turnaround and strategic nursing labour optimisation
Abstract
Healthcare systems across the USA continue to face mounting financial pressures driven by workforce shortages, inflationary supply costs, declining reimbursement rates and growing consumer expectations. Cone Health, a US$2.8bn integrated health network in North Carolina, achieved an unprecedented US$100m margin turnaround in 2023 while reducing nursing labour spend by over US$50m in a single fiscal year. This extended case study synthesises insights from Cone’s system-wide transformation and targeted nursing workforce strategies. Using financial data, organisational frameworks, cultural change methodologies and leadership narratives, this paper provides healthcare executives with evidence-based strategies for financial recovery and operational sustainability. Findings highlight the crucial role of executive leadership, interdisciplinary collaboration, data-driven accountability and cultural transformation in achieving lasting margin improvement. This paper further situates Cone Health’s work within broader scholarly literature, drawing comparisons with other turnaround case studies in healthcare and adjacent industries. It also provides extended implications for governance, leadership development, equity and long-term cultural resilience. The analysis aims to serve as an academic contribution and a practical resource for executives navigating financial recovery in complex healthcare environments. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/.
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Author's Biography
Dr Vi-Anne Antrum, DNP, MBA, RN, NEA-NC, CENP, FACHE, is a seasoned executive with more than 25 years of nursing and operations experience. She currently serves as the system-wide Chief Nursing Officer and Senior Vice President at Cone Health, an integrated health system in Greensboro. Throughout her career, she has received multiple honours, including the Cone Health COVID Legend Award (2020), the NC Great 100 Nurse Award (2021), the Triad Nurse of Distinction Award (2022) and the Triad Business Journal Outstanding Woman in Business Award (2023). In 2024, she was recognised with the American College of Healthcare Executives (ACHE) Exemplary Service Award, and in 2026, she was named to Becker’s Chief Nursing Officers to Know. Dr Antrum also serves as the ACHE Regent for North Carolina.
Deno Adkins, MBA, MHA, FACHE, serves as the Senior Vice President, Ambulatory & Consumer Services at Cone Health, a private, not-for-profit integrated healthcare delivery system with more than 13,000 team members, 2,000 employed as well as affiliated providers and over 175 locations. He leads the strategy, growth, development and operations of Cone Health’s outpatient facilities, sites and services across the network. These include 6 MedCenter campuses, 13 urgent care centres, the network of Cone Health’s worksite clinics at businesses throughout the state and other outpatient locations that provide care outside the hospital setting. Adkins joined Cone Health as an administrative fellow, where he precepted under the leadership of the health system’s Chief Executive Officer. He has held previous roles, including Vice President, Ambulatory Network; Executive Director, Ambulatory Services; Director, Health Services and Project Manager, Ambulatory Network Development. He is a member of the health system’s Enterprise Strategy Council, the Enterprise Operating Council and, in 2024, he led and chaired the health system’s Senior Leadership Council, which exceeded its annual goals to achieve top-tier performance across patient care and consumer operations, quality, employee experience, health equity and financial re-investment (margin). He is a member of the Advisory Board for Cornell University’s Institute for Healthy Futures, Ithaca.
Nicole Powers Tate, MPH, is the system-wide Director of Business Development for Operative Services at Cone Health. She specialises in perioperative operations, ambulatory surgery centre development and healthcare financial performance improvement. Nicole holds an MPH in health administration from East Carolina University, Greenville.
Shaina J. Shapera, MHSA, PMP, specialises in provider–payer relationships, value-based care, ambulatory services and population health, applying her expertise to elevate healthcare quality for her organisation and community. She currently serves as a program manager at Cone Health. Prior to relocating to North Carolina in 2022, Shaina was a Project Specialist and Administrative Fellow at Hartford HealthCare, where she managed diverse quality and safety projects across care environments. Shaina is a Certified Leadership Coach, having completed Positive Coaching Solutions Leadership Certification Program. She earned her Lean Six Sigma Green Belt in 2023 and the Project Management Professional certification in 2025. Shaina earned her MHSA from the University of Michigan School of Public Health, Ann Arbor, where she was awarded the Dean’s Scholarship. She earned her BA with highest honours in economics and human health from Emory University, Atlanta.
Citation
Antrum, Vi-Anne, Adkins, Deno, Tate, Nicole Powers and Shapera, Shaina J. (2026, September 1). Transformational leadership in health care: A case study of Cone Health’s US$100m turnaround and strategic nursing labour optimisation. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 11, Issue 1. https://doi.org/10.69554/RZKJ3091.
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