By Hospital boards typically scrutinize three line items above all others: labor, pharmaceuticals, and capital equipment. A fourth line, rarely tracked but consistently expensive, has begun to attract attention: communication failure. Grammarly’s workplace research, cited in coverage of Fort Lauderdale consultant Nicholas Mukhtar’s work, estimated that poor communication costs U.S. businesses $1.2 trillion annually. The healthcare share of that number is substantial.
Mukhtar’s practice, Tera Strategies, advises medical directors and hospital leadership on operational problems that often look financial on the surface and turn out to be conversational underneath. His starting assumption, repeated across recent interviews, is that the most expensive line in many hospital budgets is the conversation that never happened.
What the Cost Looks Like in a Clinical Setting
A delayed handoff between an outgoing and incoming shift produces duplicate tests and repeated charting. A miscommunication between an admitting physician and a discharge planner leaves a bed unavailable for the next patient. A clinical team and an administrative team using different definitions of the same metric arrive at different conclusions in the same meeting. Each of these costs time and money. Most of them never show up on a single line.
Margins weren’t designed to absorb the inefficiency. Hospitals entered 2026 with a median year-to-date operating margin of negative 0.3 percent in February, according to Strata Decision Technology data. When the margin is razor-thin, every misaligned conversation compounds across the operating year, with costs that run through clinical care and financial performance both, well beyond what a quarterly write-off captures.
Where Mukhtar Locates the Failure
Mukhtar’s diagnosis is consistent regardless of industry. “I kid you not, that seems to be 90% of the problems across the board,” he told Insights Success. “It’s just people need to talk.” The phrase sounds elementary. The implementation almost never is.
For a medical director, the communication problem manifests as competing demands on attention. Compliance paperwork eats half the day. Cross-functional meetings get rescheduled. Sensitive conversations get email-chained until urgency has dissipated. The downstream cost is care decisions that arrive late and clinical priorities that lose visibility within the broader administrative agenda.
Building Communication Into the Operating Model
Mukhtar’s recommendations for hospitals follow the same pattern he uses for corporate clients. Codify the decision rights. Establish a meeting cadence that actually serves the clinical and operational needs of the institution. Document escalation paths so disagreements between departments do not have to travel through one person’s calendar.
McKinsey’s own research found that even high-performing companies carry a 30 percent gap between what a strategy is capable of delivering and what the operating model actually produces, per South Florida Reporter’s coverage of Mukhtar’s analysis. That gap closes when communication architecture supports the clinical mission rather than competing with it.
Why the Frame Travels
Mukhtar’s preparation for hospital advisory comes from his decade in public health. He founded Healthy Detroit, served on the board of Trinity Health System’s Livonia hospital, and sat on Wayne State University School of Medicine’s External MPH Advisory Board, according to Healthcare Business Today. He earned dual master’s degrees from Johns Hopkins as a Bloomberg Fellow.
That history feeds his case. A hospital’s communication problem is a hard financial exposure that compounds inside the operating budget every week the underlying structure goes unaddressed. Hospital boards that begin tracking it the way they track labor cost, in his reading, will find more recoverable margin than any single procurement initiative is likely to deliver.
