Healthcare leaders across the U.S. are at a pivotal crossroads: costs are up, margins are down, and simply adopting new technologies or processes won’t move the needle without genuine change management. The conversation is shifting from “what’s the latest tool?” to “how do we actually solve for value, efficiency, and impact?” Nowhere is this more evident than at University Hospitals in Cleveland, where David Sylvan, MBA, serves as Chief Strategy, Innovation & Marketing Officer. In a recent podcast interview, Sylvan unpacks why the old playbook—where strategy, innovation, and marketing lived in silos—no longer works and how integrating these functions is not just a differentiator, but a necessity.
This article translates that podcast into a story-driven, practical guide for executive leaders, board members, and advanced students. You’ll hear direct from Sylvan, whose journey from investment banking to mission-driven healthcare offers lessons that are both sobering and inspiring. The takeaways: integration is hard, but it’s the only way forward; and real transformation means starting with the problem, not the solution.
Q: Why would a finance executive choose healthcare, an industry notorious for slow change and thin margins?
David Sylvan’s path to healthcare wasn’t linear. “I did work in professional sports… then I did go to a broker dealer and an investment banking platform known as KeyBanc Capital Markets. Candidly, never thought about joining the ranks of healthcare—largely for the reasons you point out. It’s not for the faint-hearted… there are crash-easier ways to make more money.”
But a consulting assignment at University Hospitals to help build an innovation platform changed his trajectory. “Something happened, Cole—I candidly found, not to get sappy, but I found mission. I found an opportunity to, as a non-clinician, impact lives perhaps. There’s a lot to be fixed in healthcare… and that’s what keeps me engaged.”
Takeaway: For top leaders, purpose trumps profit. If you’re wondering how to recruit or retain exceptional talent, mission alignment is not a “nice to have”—it’s foundational.
Q: Why do healthcare systems need to stop treating strategy, innovation, and marketing as separate functions?
David Sylvan doesn’t mince words: “The error that many of us made previously was thinking about innovation in its own bucket, strategy in its own bucket, and occasionally the two intersected. What we’re trying to do—what many systems are doing—is ensure there’s a common thread between innovation, strategy, and how we think about care delivery models.”
The argument is simple:
Outcomes are suboptimal when functions operate in silos.
Resources are wasted on duplicative efforts.
No organization has the bandwidth to support misalignment.
As Sylvan puts it, “Innovation and its marriage to strategy, I think, is an imperative. No system nationally can afford not to be innovative from the perspective of care delivery, physical plant, and the patient as the consumer.”
It’s partly financial, Sylvan admits: “If you’re living in a comfortable, positive net margin environment… you can afford to make a couple of mistakes. Now we’re all facing headwinds—efficiencies, throughput, collaborations, all these things need to be elegantly woven together.”
For U.S. healthcare leaders: The message is clear: Don’t wait for crisis to force integration. Proactively braid your core functions together or risk obsolescence.
Q: Why hasn’t technology—EHR, AI, automation—delivered the expected ROI in healthcare?
Sylvan is blunt about the myth of the “magic tool”:
“There’s this notion that if I just turn the tool on, it will create the outcome that was promised. What’s really needed is behavioral change. Users must adapt and integrate themselves with the technology so that it isn’t just quicker, faster—it’s quicker, faster, better.”
What’s missing?
User engagement in tool selection and design.
Alignment of process, people, and technology.
Ongoing change management, not just technical deployment.
He adds, “The combination of person and process, or person and tool, is where the secret sauce resides—not a false reliance on just the existence of the tool.”
Key insight: If you want sustainable ROI from innovation, you need to change hearts and minds, not just systems.
Q: How do you actually get buy-in and behavioral change at a massive organization?
University Hospitals manages over 200 physician offices across 16 counties, with revenues exceeding $6 billion. Sylvan doesn’t sugarcoat the challenge: “The biggest mistake organizations can make—and we made this mistake—is by cramming down, by forcing adoption of a tool or technology, disrupting workflows without pre-buy-in, and not having users at the table during the process.”
Instead, his team focuses on:
Relentless problem understanding through engagement.
Reverse engineering solutions starting from actual pain points.
Flipping the script: Involve users early in opportunity selection, not just in implementation.
“It’s never an N of one. It’s always a team approach, bringing in people with the right vernacular and language to provide the interface between what innovation is seeking and what clinicians are solving for.”
Practical approach:
Include clinicians with a design mindset in every innovation team.
Use co-design and iterative feedback.
Be honest about “mixed results” and adjust as needed.
Q: Can hiring non-traditional leaders—those without a clinical background—work in healthcare?
University Hospitals proves it can. Sylvan, who is not a physician, credits leadership’s willingness to take a risk on non-traditional hires: “It was initially seen as an experiment… but as the experiment began to yield results, and we amplified the positive through storytelling and engagement, it took on a life of its own.”
He’s adamant about the value of industry diversity:
Prevents groupthink and myopia.
Brings in outside-the-box solutions.
Pairs non-clinicians with tight clinical thought leadership.
“My intention is always to look for those who bring diversity of background, experience, and thought—and then pair those with strong clinical leaders to get a better outcome.”
Advice for other systems: If you want different results, you need different perspectives. Pair industry outsiders with clinical leaders and foster intentional collaboration.
Q: How do you bring in outsiders without sacrificing patient care or turning into a profit-driven machine?
Sylvan answers directly: “It’s critical to always reinforce the true north. In University Hospitals’ case, the most needy or the most worthy is never far from our minds. We don’t turn down any patients. We’re consistently looking at our community impact.”
Practical advice for leaders:
Constantly communicate your mission and values.
Hire people who buy in to that purpose.
Use mission as a filter for every major decision.
When mission and margin compete, mission wins. But when you “inculcate the institution with that ethos,” you’ll also find financial sustainability follows.
Q: Why combine strategy, innovation, and marketing in a single executive role?
Sylvan is one of the few in the country with all three in his title, and it’s no accident. “One of our observations is that marketing can reside in a silo. Its role is to amplify brand and effectuate patient capture… but what we’ve chosen to do is find the commonality between strategy, innovation, and marketing—and that’s data and insights.”
How does this work?
Marketing campaigns are driven by real-time data on patient needs and service line performance.
Strategic vision is amplified, not diluted, by marketing efforts.
Innovation is grounded in what patients and communities actually want and need.
He summarizes: “If you step back and think about the common language of data and insights, there is a compelling ethos behind that.”
Q: How can one leader effectively manage multiple executive roles—and should your organization do the same?
Sylvan credits his executive assistant but also his own wiring: “I have no secret sauce or silver bullet… but I do need to be engaged and busy. I bring learnings and vignettes from one domain to the next, which keeps me in growth mode.”
He suggests:
Leverage a top-tier executive assistant.
Look for “overlap value” where insights in one domain inform another.
Recognize that this approach isn’t for everyone—but for some, it’s a force multiplier.
For organizations: Don’t combine executive roles by default. But if you find the right person, it can bring a level of integration and cross-pollination that siloed roles cannot.
Q: What is University Hospitals Ventures and why does it matter?
“The ventures platform is the investment and commercialization platform for the system. We look for opportunities within our own IP portfolio to see if there might be commercial viability—from licensing agreements to company formation.”
The process:
Start with the problem, not the solution.
Identify technologies that solve for real needs.
Pilot, trial, and measure outcomes—then invest if both ROI and impact are there.
Pursue both internal (spinouts, IP) and external (joint ventures, NASA agreements) innovation.
Sylvan makes a point to avoid “technology transfer” as a limiting concept: “We prefer ‘technology commercialization’—it’s broader, more encompassing.”
What’s the impact? UH is among the most active systems in the country for joint ventures, including major partnerships with technology firms and even NASA.
Q: How do you collaborate with non-healthcare organizations without losing your edge or wasting time?
Sylvan’s approach is refreshingly humble: “We don’t underestimate anyone. Healthcare is complex—but so are other industries. Knowledge is fungible. If you can figure out something in domain A, there’s a good chance you can figure it out in domain B.”
Two tactics:
Bring your clinical and domain expertise to the table—but listen and learn from partners’ domain strengths.
Shed the ego. Be open to solutions that may have been perfected elsewhere.
“Every company is going to have a health and life sciences component anymore—we’re all patients, we all need providers. But we also need tools, technologies, and offerings from other domains.”
Action for leaders: Cultivate partnerships with non-traditional players. Be open to being taught, not just teaching.
The lesson from David Sylvan’s leadership at University Hospitals is stark: the days of siloed strategy, innovation, and marketing are over. The only way to thrive—financially and missionally—is to integrate, co-design, and relentlessly focus on real problems, not hypothetical solutions. Technology alone will never save you; change management and humility will.
If you want to build a high-performing, mission-driven, and financially sustainable health system, start by breaking down your own silos and seeking partnerships—inside and outside the industry. True transformation, as Sylvan models, is a team sport.
