The most expensive thing a new hospital CEO inherits is the exception list.

Hospital CEO turnover ran 32 percent higher in the first quarter of 2026 than the year before. Behind that number is a simple picture: right now, an unusual number of hospital leaders are in their first 90 days, inheriting an EHR they didn't pick, a contract they didn't sign, and a decade of decisions nobody wrote down.

Here is what that inheritance costs when it goes unread. Cone Health is spending at least $40 million to rebuild the foundation of its Epic system. Not to replace it. To rebuild the same platform, after 14 years of accumulated customization and bolt-on applications left it unable to adopt capabilities the vendor now ships as standard. Cone's own estimate: $10 to $20 million in recoverable opportunity was sitting in unused best practices and redundant third-party tools. And the fix they chose is telling. Alongside the technical rebuild, they rebuilt governance, putting operational and clinical leaders in charge of the committees that evaluate every enhancement, with IT embedded as advisors.

That matches what the data says drives outcomes. KLAS's Arch Collaborative, surveying more than 121,000 clinicians across 92 organizations this year, found that the strongest contributors to clinician EHR satisfaction include shared ownership and governance, not which logo is on the login screen. Only 22 percent of clinicians rate their EHR experience at the highest level. Among nurses, 12 percent. The gap between those numbers and the status reports on a new CEO's desk is real, and it is measurable.

So if you are one of the leaders in your first 90 days, here is the read I would do before committing to any system decision. Three audits, all doable with the team you already have.

Audit the dates. Not the spend, the dates. Term end, support step-downs, auto-renewals. Every one of those dates is a decision you now own, and the calendar does not care that you just got here. Leaders who discover a renewal date at month 22 of 24 negotiate from their knees.

Audit the exceptions. The workflows that bypass the standard, the department that kept its legacy tool, the interface built for a director who left years ago. Each one was reasonable when someone approved it. Compounded over a decade, they are how a health system ends up spending $40 million to rebuild software it already owns. You do not need to fix them in 90 days. You need the count, and the name of the person with authority to retire one. If that name is nobody, that is your finding.

Audit the decision rights. Who can say no to a one-off. Who owns the standard. Who can move a date, and what evidence they need. This is the audit the other two roll up into, and it is the one the satisfaction data keeps pointing at.

Then go watch a shift. Not a listening tour, a shift. Watch a nurse chart a med pass. Watch registration build an account. Watch a biller work a denial queue. The distance between what the demo showed and what the night shift does is the most honest metric in the building, and the nursing numbers above say that distance is probably wider than anyone has told you.

Ninety days of questions costs nothing but calendar. The exception list compounds either way. So here is the question worth asking in your first week: who in your building has the authority to retire an exception, and when did they last use it?