'Flow Like Water': The Culture Philosophy Reshaping Tampa General Under John Couris

The CEO of the nonprofit health system shares how his leadership approach has evolved and helped the organization navigate years of volatility and growth.

After eight years guiding Tampa General Hospital, president and CEO John Couris has developed a leadership philosophy that’s allowed the organization to be fluid during a period of constant change.

“You have to flow like water,” Couris tells HealthLeaders, using the metaphor to describe water as something that doesn’t resist or panic, even when obstacles appear.

In a volatile healthcare environment in which hospitals and health systems are contending with rising costs, stagnant reimbursement, and shifting political pressures, Couris believes reactivity can be fatal.

“If a leader tends to knee-jerk, overreact, uses their limbic system and not their frontal lobe to make decisions, so will the organization,” he says. Couris’ approach aims for the opposite, emphasizing steady, rational adaptation that keeps people grounded.

That mindset forms the foundation for how he’s reshaped Tampa General during his tenure through cultural durability, disciplined strategy, and a relentless focus on value.

When Couris talks about Tampa General’s evolution, he repeatedly returns to culture as the architecture holding the system together, anchored by four behaviors. “When you treat people with authenticity, kindness, transparency, and vulnerability, really interesting things happen,” Couris says.

It creates engagement, psychological safety, and trust, three elements he ties directly to Tampa General’s performance. Employees are expected to be open and comfortable admitting mistakes, and leaders, in turn, model the same.

The impact is measurable. Last year, 92% of Tampa General’s 15,000 employees reported being fully engaged, according to Couris, who connects that directly to the organization’s ability to innovate and execute.

“You cannot innovate, you cannot challenge the status quo, you cannot get comfortable with failing” unless psychological safety exists, he says. Tampa General encourages teams to “fail fast and learn fast,” paired with a culture that makes people feel safe enough to take smart risks.

Couris backs up the cultural claims with performance data that showcases top-decile risk-adjusted mortality, improved clinical quality measures, and continued growth in programs, services, and academic capabilities. “When people trust one another, organizational performance explodes—operationally, clinically, and strategically,” he says.

Couris’ philosophy extends to a core belief that his employees come first and the patient comes second. “If you can give your team what they need… they can then turn around and give the best version of themselves to their patients,” he says. The patient ultimately benefits, but only because the workforce is supported and empowered to strive for the mission.

Pictured: John Couris, president and CEO, Tampa General Hospital.

Disciplined Growth: ‘Better Is Better’

Even as Tampa General has expanded significantly under Couris’ leadership, he rejects the idea that size alone is a strategy.

“Bigger is not better. Better is better,” Couris says. He sees today’s health system consolidation not as a strategic play, but often a financial lifeline in which organizations seek a “safe harbor” when they lack capital or sustainability.

For Tampa General, growth has been intentional and selective. Couris notes that at the beginning of his tenure, the organization operated one hospital and 17 locations. Today, the portfolio includes eight hospitals and more than 150 locations across Florida. But Couris emphasizes that instead of focusing on building new acute-care facilities, Tampa General has primarily acquired existing hospitals that need reinvestment.

With average occupancy rates hovering around 60–65% in Florida, Couris questions the logic of adding more hospitals simply because population is rising. “Imagine running a business that's 60% full. Hard to do,” he says. And the economics, Couris argues, are unsustainable: “A hundred-bed hospital is $300 million. If we're not careful, health systems will crush themselves on their own weight.”

Tampa General has built where there is a clear community need, according to Couris, such as a new specialty rehabilitation hospital and a freestanding academic psychiatric hospital. Otherwise, the strategy is to strengthen systems of care, not expand them indiscriminately.

Couris frames this as both a financial and clinical necessity. Better care coordination, better quality, and better outcomes, he argues, create the real value consumers need. “Our job is to create value,” Couris says.

It also means partnering where it makes sense. Couris’ philosophy on technology and partnership is rooted in not chasing solutions, but starting with problems. Many vendors, he says, offer technology that is “a solution looking for a problem.” Tampa General’s approach is to define the problem clearly, validate it, then seek the right partner to solve it.

That mindset led to some of Tampa General’s most significant innovations, including its AI-enabled operating system through its partnership with Palantir. It also underpins local collaborations like Tampa Bay Thrives, a multi-system, multi-agency effort to address mental health needs regionally.

“Nobody can be the best at everything,” Couris says. “You need to partner. You need to collaborate.”

Ultimately, Couris sees Tampa General’s culture, growth, partnerships, and value as an extension of leadership behavior. And for him, the model remains the same as the metaphor he began with.

“You have to flow like water.”