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Busier Than Ever, Yet Margins Stay Thin Across the country, independent hospitals are carrying more than their share of the weight. Whether you lead a community hospital in Arizona, a safety-net facility in the Midwest, or a regional medical center in New England, the feeling is the same. Your emergency department is busier than it has ever been. Your outpatient clinics continue to absorb everything that upstream clinics can no longer handle. Your teams are working hard, solv

One day a woman was making dinner when her husband asked, “Why do you cut the roast in half and bake it in two pans?” She answered, “I don’t know. My mom always did it that way.” That led to her mom, who said the same thing. Finally she asked her grandmother, who replied, “Sweetheart, I only had pans that small.” Three generations followed a system with no reason behind it. Nobody stopped to ask “why.” Outpatient healthcare is full of moments just like this. Not because peopl

If We’re Working This Hard, Why Aren’t We Winning? Let's be real. Every day in outpatient healthcare is a hustle. You clock in, charts pile up, and the patients keep cycling through. Decisions stack up minute by minute. You and your team are working hard, really hard. But here’s the painful part: Hard work doesn’t automatically equal progress. You look around and ask yourself, "If we're moving this fast, and everyone is giving 110%, why are we still fighting the same battles?

After I published the Founder-Led piece, I kept thinking about what felt unfinished. I explained how I work, but not why this work keeps pulling me in. Something was missing, and I realized it was the part I never really put words to. The part that shows up in the quiet corners of outpatient care where the pace is fast and the details matter. Cigal has been around since 2010, shaped by years of hands-on experience before that. We are not a new company. We are simply stepping