This letter appears in HealthBegins’ May 2026 newsletter.

Dear friends,

Imagine you’re the leader of a hospital department — be it clinical care, population health, or community benefit. You came to this work because you believe hospitals can and should be anchors of community health. You’ve spent years leading programs to treat and prevent disease, close care gaps, and address food insecurity, housing instability, and poverty — the root causes of health inequities in your community.

Now, federal policies and actions are slashing Medicaid funding, freezing grants, rolling back public benefits, and undermining the support that many patients depend on. These changes translate directly into reduced capacity to serve patients, including people experiencing poverty, unmet social needs, and the accumulated harms of long-standing health inequities.

At the same time, the communities most affected by these actions — low-income families, immigrants, people with disabilities, rural residents — are the very populations your hospital’s mission exists to serve. Your community and employees are struggling with fear and uncertainty. You’re squeezed between the imperative to sustain institutional operations and the moral obligation to protect the people who have nowhere else to turn, as well as those who care for them.

This is not a management problem. It is a moral crisis — and it has a name.

Moral injury: When values and harmful policies collide

In September 2025, the American Psychiatric Association formally recognized moral injury in its diagnostic manual — a landmark acknowledgment that the distress arising from ethical violations is clinically significant and demands attention. Moral injury is not burnout. It is the psychological and spiritual wound that forms when you are forced — by resource constraints, institutional pressures, or policy decisions beyond your control — to act in ways that contradict your deepest values or witness preventable harm.

I’ve talked with hundreds of health professionals over the last year, and I believe many are experiencing moral injury. For hospital leaders and frontline workers right now, moral injury may look like the weight of canceling a health program that was working. The helplessness of watching patients lose Medicaid coverage and knowing what comes next. The frustration of seeing a scientific committee co-opted, an important meeting cancelled, or a report censored. The quiet grief of a workforce that entered healthcare to heal and is instead being asked to triage a policy-made disaster.

Naming this matters. Because leaders who understand what they are experiencing can begin to move through it — not just survive it.

Move from injury to agency — together

This week in Dallas, my colleague Glasha Marcon and I will be at the American Hospital Association’s Healthier Together conference specifically to connect with leaders like you — leaders who haven’t given up, who are still looking for ways to protect their communities and their mission despite the headwinds. We’re sharing two essential solutions from HealthBegins designed to help move from moral injury to real, practical agency. One: unlocking and aligning capital and finance flows for population health and health equity. And two: building concrete skills and strategies that professionals and hospitals can use to overcome threats to vulnerable communities and the workforce and institutions that serve them.

To unlock and align capital and finance flows, we’ll share resources and tools to help hospital leaders measure, optimize, and sustain vital programs and investments — tools like Blended Value financial modeling, Community Health Detailing to boost enrollment, and G-codes to unlock Medicare reimbursement for Community Health Workers. Hospital leaders in Texas, Michigan, California, and other states are now seeing these strategies click, unlocking the true value of this work and a sense of shared purpose among departments and leaders. When siloes melt and merge, that alignment enables health system leaders to be more effective leaders in their community, to ensure that money moves to the people, places, and programs that need it most. 

To build skills and strategies, we recognize that threats to vulnerable communities and their hospitals have intensified as federal actions increasingly challenge the integrity of medical, scientific, and democratic institutions and providers find themselves at the frontlines. At AHA, we’ll share practical skills and evidence-informed strategies that professionals and hospitals can deploy right now to overcome these threats — including our Health Equity Policy Hub and a set of collaborative actions to share risks and resources, coordinate responses, protect the rights of patients and co-workers, and build solidarity with community-driven, pro-democracy movements.

We believe that moral injury, left unaddressed, depletes the very leaders and professionals who are most essential to providing healthcare for all. The antidote to our current injury is not simply resilience — it is shared agency: leveraging tools, strategies, and community to act meaningfully.

Find us in Dallas this week; we’d love to connect. Or find us online; I’ll be talking today in this webinar about steps to shape the future of public health. Either way, please reach out if you’re a health system leader who wants to help your institution do better in the face of present challenges. We’ll move from moral injury to agency — together.

Best,

Rishi