Chief operating officers: Exploring a new managerial role in healthcare

Background The rise of Chief Operating Officers (COO) in healthcare is filled with the expectation to improve demand and capacity management practices from a system perspective. Given the absence of empirical studies on the role of COOs in healthcare, this study explores the establishment and scope of COOs in Sweden, their responsibilities, decision-making authority, and the conditions influencing their role. Methods An interview study with Swedish healthcare COOs. Open-ended responses underwent qualitative content analysis; closed-ended items were summarized as counts and percentages. Two frameworks were combined: Healthcare Services Operations Management and the Decision Space Framework. Results The study identifies key areas of responsibility for COOs, such as demand and capacity management, data-driven operations, and cross-organizational coordination. COOs operate at the intersection of centralized and decentralized management practices, requiring collaboration with CEOs and department managers. The study highlights the importance of organizational and individual capacities, including team competencies and a deep understanding of healthcare operations. Conclusions COOs have the potential to improve coordination of demand and capacity management and thereby support healthcare system efficiency. By clarifying decision spaces and ensuring demand and capacity management competencies and data infrastructure, the COO role can more reliably translate a system perspective into operational results.