ZSFG CEO puts healthcare disparities at the center of hospital leadership
Susan Ehrlich, MD, brings an unusual combination of roles to Zuckerberg San Francisco General Hospital and Trauma Center: hospital chief executive, primary care internist, UCSF professor and practicing clinician. That blend matters because it gives her a bedside view of what patients experience and an operational view of where systems fail them. In a healthcare environment increasingly focused on efficiency and financial pressure, Ehrlich is arguing for a different priority to remain in plain view: healthcare disparities.
Her perspective is shaped by a career path that did not follow a standard administrative track. She earned her medical degree midcareer and now continues to see patients while leading a major safety-net institution. The clinical work is not ornamental to her leadership style; it informs how she thinks about policy, operations and advocacy. A physician who still follows a panel of about 125 patients and spends time in clinic almost every Thursday morning sees structural gaps differently than a leader whose exposure is limited to dashboards and budget meetings.
The pandemic sharpened that view. ZSFG moved into a new acute care tower shortly after Ehrlich arrived, then underwent a major technology transition with the launch of Epic in 2019, and within months the COVID-19 pandemic rearranged nearly every routine in the hospital. The crisis forced hospitals to think not only about capacity and infection control, but also about how patients entered the system, how trust was built and which communities bore the heaviest burden when access became more difficult. At ZSFG, that experience strengthened ties with the San Francisco Department of Public Health and made the hospital more attentive to the front door of care — who gets in easily, who does not and why.
One point runs through Ehrlich’s remarks with particular force: disparities do not sit at the margins of clinical care. They appear wherever outcomes are measured.
Why the data keep pointing back to unequal outcomes
Ehrlich’s argument is grounded in a simple but stubborn pattern. Across conditions as different as cancer detection, diabetes control, blood pressure control and access to care, the data repeatedly separate patients into groups that are doing well and groups that are not. Those differences are not confined to a comparison between wealthy and resource-strained institutions. They can exist inside the same hospital, among patients served by the same clinicians and the same electronic record.
That matters because disparities are not just a reflection of individual biology. They are often the visible endpoint of differences in access, continuity, language support, transportation, insurance coverage, trust in the health system and the ability to return for follow-up. A patient who misses screening for a preventable malignancy is not only missing a test; that gap can delay diagnosis until the disease is more advanced and less curable. A patient with uncontrolled hypertension may not simply need a different medication dose; the problem may also involve cost, health literacy, competing demands, unstable housing or limited opportunities for longitudinal care. In that sense, disparities are clinically actionable signals of system failure, not abstract equity metrics.
Her comments also place a hard truth in front of health system leaders: efficiency efforts alone do not erase unequal outcomes. Hospitals can modernize technology, improve revenue cycle performance and launch new service lines while still leaving disparities untouched. The operational challenge is to examine where the system itself is amplifying risk. That can include how patients are triaged, how follow-up is scheduled, how referrals are closed, how outreach is conducted and how teams respond when barriers emerge after discharge.
Leadership, persistence and the work of closing gaps
Ehrlich’s advice to a successor is less about image than about execution. She describes effective leadership as the ability to shift between strategic altitude and on-the-ground problem solving. A hospital CEO has to set direction, but also has to notice when barriers inside the organization are preventing patients and staff from getting what they need. For disparities work, that dual view is essential. Equity strategies often fail when they are treated as side projects rather than core operational work with measurable accountability.
Patience is the second trait she names, and it fits the timeline of disparities reduction better than quick-fix rhetoric. Many inequities are embedded in referral patterns, historical underinvestment and longstanding social conditions. Progress can be real and still slow. Hospitals may need years to redesign outreach, improve access points, build community partnerships and align clinical workflows with the needs of populations that have been underserved. The gains can be incremental, but the clinical stakes remain immediate.
At ZSFG, the community relationship is not an accessory to the mission; it is part of how the institution operates. That is especially relevant in a safety-net setting, where public health, hospital care and community trust overlap. If disparities are visible in screening, chronic disease management and access, then the response cannot live inside one department alone. It has to involve leadership, front-line clinicians, data teams, community partners and public health agencies working from the same set of priorities.
For Ehrlich, the case for keeping disparities in focus is not theoretical. It is visible in the same place she sees patients, manages a hospital and shapes policy. If health systems want different outcomes, they have to look at where the current ones are being produced — and then stay with that work long enough to change them.