Why One CFO’s Workforce Strategy Is the Real Margin Story

As labor pressures eclipse payer mix and inflation, HSHS CFO Amy Crouch explains how tighter governance, financial literacy, and operational partnership are reshaping workforce management in a post-COVID reality.

Amy Crouch has been named CFO for the Hospital Sisters Health System’s Wisconsin market, which includes HSHS St. Vincent Hospital in Green Bay; St. Mary’s Hospital Medical Center in Green Bay; St. Nicholas Hospital in Sheboygan; and St. Clare Memorial Hospital in Oconto Falls.

Crouch had been serving as interim CFO for the Wisconsin market since fall of 2025 and comes to HSHS after serving as CFO at Riverview Health in Noblesville, Indiana. With 25 years of healthcare finance experience under her belt, she steps into her new role with a collaborative, results-driven leadership style and expertise in strategic financial improvement planning and execution.

Crouch says one of her most effective strategies is partnering with operational leaders on every challenge, ensuring that every leader in the system understands the finance fundamentals of the workforce.

When Labor Becomes the Margin

Crouch explains that labor pressures—more than payer mix or inflation—have been the biggest margin driver in her new market, and they’ve been driven largely by seasonal spikes that require costly contract labor and purchased services.

During periods like flu season, high patient census levels force many health systems to bring in external staff, like travelling nurses, to support permanent teams, significantly increasing expenses. To address this, Crouch is formalizing a tighter governance process around contract labor, including clear documentation of need, duration, cost, and exit plans. Her goal is to actively monitor volumes and scale back external staffing as demand eases, rather than letting these costs linger.

“Labor is definitely, of those three, the biggest driver,” she says, emphasizing the importance of ensuring that contract costs “don’t fall off anyone’s radar” once census levels decline.

She says one of the most underappreciated financial risks in healthcare today is the growing shortage of clinical providers, which is driven less by demand than by bottlenecks in education and training. Aside from physician shortages persist, she points to even steeper constraints for nurses and allied health professionals such as radiology technologists and respiratory therapists.

“Schools will have 60 applicants for 12 spots,” she says, calling out the limited capacity of training programs a structural challenge for the industry.

At HSHS, her response has been to deploy a familiar playbook focused on building financial literacy across the organization so leaders can better manage labor, reimbursement, and margins amid workforce scarcity. She has rolled out a year-long, tiered education plan tailored to different roles—from frontline staff to the board—starting with basic finance fundamentals and progressing to detailed instruction on departmental income statements, reimbursement mechanics, and denial management.

 “It’s easy to say everybody needs to understand the financials,” she says, “but how are we going to teach them?”

Her goal, she adds, is not just vision-setting but “operationalizing the vision” so leaders can take informed action in a tight labor and reimbursement environment.

Crouch says labor management in Wisconsin’s healthcare marketplace has shifted dramatically post-COVID. Before the pandemic, staffing decisions were typically guided by productivity benchmarks, but now the priority is simply ensuring adequate staffing.

 “Post COVID, everybody is just trying to ensure that they are staffed,” she says, noting that the challenge extends beyond clinical roles to other key positions, such as accountants and CPAs.

This new reality requires balancing labor costs with maintaining access and quality, even amid widespread workforce shortages.

Curiosity > Perfection

Crouch urges emerging CFOs not to let uncertainty undermine their confidence, emphasizing the importance of mentorship, curiosity, and teamwork when stepping into a first-time or interim CFO role. Drawing on her own experience developing future CFOs, she stresses that the role’s complexity and high stakes do not mean leaders have to navigate it alone.

“Do not be afraid,” she says, noting that healthcare finance is fundamentally “a team sport. “You can do hard things.”

She encourages new CFOs to actively seek mentors and build a “personal board of directors” made up of trusted advisors and diverse thinkers who can offer guidance on finance, leadership, and strategy. That board, she says, doesn’t have to be formal. Insights can come from podcasts, audiobooks, or just well-known business leaders.

Ultimately, she says, success sprouts from asking the right questions, building strong relationships across clinical, operational, and financial teams, and staying grounded in the mission.

“Stepping into the CFO role is a big moment,” she says, “but you don’t have to carry the weight alone.”