Spotlight On: Todd Caliva, CEO, HCA Healthcare Houston

Key points:

• • HCA Houston Healthcare is expanding services and access points as the region rapidly grows.
• • Investments in women’s care, cardiovascular services, and technology are keeping more care local.
• • CEO Todd Caliva says workforce development and patient access remain key priorities.

May 2026 — Invest: sat down with Todd Caliva, CEO of HCA Houston Healthcare Clear Lake and HCA Houston Healthcare Mainland, to discuss the region’s rapid growth, evolving care needs, and how HCA is expanding access across the metro area. “I want to make it so that no one has to leave the Bay Area for healthcare. The goal is to keep people close to home and to offer the depth of services that make that possible,” Caliva said.

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What makes the Houston region strategically important for HCA Healthcare’s broader network?

Houston is a large, diverse city, and it is growing quickly. We have upward of 8 million people in the surrounding areas, and that creates a rising demand for healthcare services. From an HCA perspective, this is one of the largest divisions in the company. We have 16 hospitals total, 13 in Houston and three in South Texas, including facilities in Corpus Christi, the Rio Grande Valley, and McAllen. It has been a big city for the company.

When you look at where people are moving, a lot of growth is happening in the southern and northern parts of the region. In the south, there are several reasons: strong school districts, proximity to downtown Houston and the Texas Medical Center, and access to high-quality healthcare. I believe Clear Lake is the most dominant and complex hospital in this region. We do everything except transplant services, so people do not have to go into the medical center for most needs.

There are also quality-of-life factors. Contrary to what some people believe, I still consider Galveston a beach, and being about 30 minutes from the beach is attractive to a lot of families.

More broadly, Houston’s economy is far more diverse than it was years ago. Houston used to be heavily dependent on oil, and now you see a range of employers bringing people into the region, including major anchors like NASA and other large organizations. Add to that the cost of living, and it is a city that continues to draw new residents. As the population grows, healthcare demand grows with it, and that is a key reason the company has expanded so rapidly here.

We have expanded beyond hospitals as well. We have freestanding ERs, urgent care locations, and ambulatory surgery centers because access points matter, and care is increasingly delivered in settings that are closer to where people live.

With population growth in mind, what major shifts have you noticed in patient needs, and how are you adapting?

Two things are happening at the same time. The population is getting older, and you see more cardiovascular disease. That is why we have focused so heavily on our cardiovascular program. We did over 500 open hearts last year, and that is something that makes me proud. As demand rises, we have strengthened our cardiovascular service line to meet what the community needs.

At the other end of the spectrum, young families are moving into places like Friendswood and League City. That makes women’s and children’s services a major priority. We delivered over 4,000 babies over the last two years, and we have broken delivery records for the last five years. I want Clear Lake to be the preeminent and safest hospital to deliver a baby.

To support that goal, we have resourced women’s services so families know they have the right care at the right time. We have 24/7 OB hospitalist coverage, 24/7 anesthesia coverage, and 24/7 neonatology coverage, and we are a Level III NICU. For me, it is about aligning resources around the service lines that are growing and building programs that reflect the community we serve.

How are you investing in facilities, services, and technology to improve the patient experience?

We are in the middle of a major construction project that, when you add it all up, is close to $200 million. If you come to the hospital, you will see the cranes. We are adding three floors to our main tower. On the east side of the hospital, we are adding another three-story tower that will incorporate women’s services and expand our labor and delivery capacity. That project will effectively double our capacity by adding 15 LDRs, and it directly connects to the growth we are seeing in the community.

We also purchased the Kindred facility across the street for an expansion of rehab services. Our inpatient rehab unit is full every day. As the population ages, more patients need rehab, including patients recovering from orthopedic and total joint procedures. The company has been supportive in giving us the capability to expand in that direction.

On the technology side, we have invested heavily in minimally invasive approaches when appropriate. We have advanced surgical robotics and minimally invasive orthopedic robotics that support sophisticated care with smaller incisions and, in many cases, shorter recovery. That is something we have prioritized because it improves access to modern care and strengthens what we can offer close to home.

Care is moving closer to home. How are you balancing outpatient expansion with maintaining high-acuity hospital services?

There is a clear trend toward outpatient care. With minimally invasive surgery and changing patient expectations, more procedures can be done safely in outpatient settings. That is why we have invested in ambulatory access points, including ambulatory surgery centers and dedicated outpatient sites for procedures like endoscopy and colonoscopy.

We have also expanded our access footprint through urgent care and emergency care. Under Clear Lake, we have three urgent care centers and four freestanding ERs. The urgent care centers serve growth areas such as League City, Friendswood, and Pearland. The freestanding emergency rooms are staffed 24/7 by board-certified emergency physicians, and they are located in Friendswood, Pearland, Texas City, and Alvin. These sites make it easier for patients to access the right level of care, and they create a smoother pathway into our broader system when higher-acuity services are needed.

At the same time, our hospital-based services continue to grow. The only reason someone would truly need to leave the area is for transplant services. Other than that, we do everything. Our oncology program is growing, including a strong solid tumor program, and we recently launched a blood cancer program. Our cardiovascular and neuroscience services continue to expand as well.

I want to make it so that no one has to leave the Bay Area for healthcare. The goal is to keep people close to home and to offer the depth of services that make that possible.

How is HCA addressing rising cost pressures while continuing to deliver high-quality care?

Rising healthcare costs are a real concern, and they are not sustainable at the pace we have been seeing. We are going to have to do better as an industry.

One advantage of being part of a large system like HCA is the ability to leverage size, scale, and best practices. A major part of cost management is improving efficiency without compromising quality. That includes focusing on throughput and appropriate length of stay, getting patients home sooner when it is safe, and ensuring resources are used most effectively.

It also includes ensuring care is delivered in the most appropriate setting. When appropriate, shifting services to outpatient settings is lower-cost than inpatient care. Encouraging patients to use urgent care centers instead of emergency rooms for conditions that belong there is another strategy to help control costs.

Technology will play a role, too. I am optimistic about the role that technology and AI will play in supporting decision-making, efficiency, and patient experience, especially for a system of our scale.

How are labor market trends affecting your approach to recruiting, retaining, and developing clinical talent in Houston?

Houston is one of the most competitive healthcare markets in the world. We are in the largest medical center in the world, and there are multiple major health systems competing for the same talent. People can often go to another hospital for more money, especially in hard-to-fill roles like OR nurses, cath lab techs, and other specialized positions.

Our approach has always been to create talent and develop talent. HCA is a pipeline that helps people achieve their career goals. Leadership development is a major differentiator for HCA, and it is a key part of retention. We focus on fostering talent and giving people a path, whether that is a bedside nurse growing into a charge nurse, supervisor, manager, director, or executive nursing leader.

I have been with the company for 33 years, including 10 years at Clear Lake, and the reason I have stayed is that the company has consistently helped me achieve my professional goals. We try to do that for others.

We also take workforce challenges into our own hands when we can. After COVID, nursing shortages were severe, and the company purchased a nursing school, Galen College of Nursing, so we could train nurses and build the pipeline. We are also expanding our GME efforts by training physicians through residency programs, because there is a growing physician shortage projected across the country. Those investments are essential to maintaining care quality over the long term.

Looking toward 2030, what do you see as the biggest opportunity for HCA Houston Healthcare as the region grows?

The biggest opportunity is continuing to expand alongside the region and making access easier for patients. Outpatient facilities, freestanding EDs, and urgent care centers will continue to be important because they meet patients where they are and help connect them to the broader system when needed.

Women’s and children’s is also a key opportunity. For many families, the first major healthcare experience is delivering a baby. When patients have a great experience delivering their baby, that trust often carries forward as their families grow and their healthcare needs evolve. We want to be the provider they trust across every phase of life, from young families to aging parents.

Overall, it is about following where healthcare is going, growing with the community, and ensuring patients can access high-quality care close to home.

Want more? Read the Invest: Houston report.