How a 40,000-person health system keeps internal comms clear at scale

When you’re responsible for reaching tens of thousands of employees, “just send more emails” isn’t a scalable strategy. This is the exact problem facing internal communicators at large health systems: a workforce spread across dozens of locations, most of whom are on their feet all day and rarely near a computer. Get it wrong, and important information never reaches the people who need it most. Get it right, and internal comms becomes the thread that holds a sprawling, distributed culture together!

We recently sat down with Rosanne Mottola, Internal Comms Strategist at Hackensack Meridian Health, to hear exactly how her team pulls this off — and the conversation was so good we wanted to unpack it here.

Missed it live? Catch the full session, including Rosanne’s Q&A with the audience here: 

Hackensack Meridian Health (HMH) is a great example of what “getting it right” looks like! HMH spans 18 hospitals across New Jersey and employs more than 40,000 people, a huge share of them being frontline healthcare workers who don’t sit at a desk.

As Rosanne put it, their team members are “certainly not one size fits all” — they’re in different locations, with different challenges and skill sets, and most are deskless workers with a lot on their plates.

Building a comms function that actually reaches all of them didn’t happen by accident — it took intention, consistency, and the right systems.

Here’s what any internal comms team can learn from how large health systems approach communication at scale, and why internal comms for health systems in particular deserves its own playbook.

Why internal comms gets harder as you grow

With a distributed company of 40k employees, ad hoc comms (a Slack message here, an intranet post there) falls apart fast. A few things change once you’re operating at this scale:

• Your audience isn’t one audience. Nurses, surgeons, administrative staff, and facilities teams all need different information, delivered differently.
• Most of your workforce is frontline. Healthcare workers move between patients, procedures, and shifts… and they’re *probably* not checking email between meetings.
• Consistency gets harder to maintain. With multiple hospitals and departments, messaging can drift or get diluted the further it travels from headquarters.
• The stakes are higher. In healthcare, unclear communication doesn’t just hurt employee morale, it can also affect patient care.

None of this means comms at scale is impossible! You just need a system that really works. Healthcare adds a layer most industries don’t deal with: shift-based schedules, clinical versus non-clinical staff, and information that can be safety-critical.

That’s exactly why internal comms for health systems has become its own discipline, with its own tools and playbooks, rather than a smaller version of general corporate comms.

Internal comms best practices for health systems operating at scale

A few principles show up again and again in how large, distributed organizations keep their comms clear — and each one came through loud and clear in our conversation with Rosanne:

Build for cascade 

Instead of one team trying to reach every employee directly, effective comms functions create a model where messaging flows from a central strategy through local leaders and site-level communicators — who adapt it for their team without losing the core message.

At HMH, that means a dedicated network team member is assigned to each hospital, acting as a subject matter expert who understands both network priorities and local needs. Pre-approved network content gets dropped right into local site newsletters, so every location shares a consistent voice — and the team gets cleaner analytics across every newsletter that runs it.

Choose consistency over volume 

Sending more doesn’t equal reaching more. The organizations that communicate well at scale are disciplined about what gets sent, when, and through which channel, all while protecting employees’ attention.

Rosanne’s team ships their newsletters on the same day and time every week (holidays included, because healthcare is a 24/7 operation!) so team members always know when to expect them. And because they don’t spam, a one-off email actually signals “this is urgent.”

Meet frontline employees where they are 

For a workforce that isn’t at a desk, that might mean break room screens, mobile-first updates, shift huddles, or SMS! HMH leans on digital screens in team-member-facing areas with QR codes that link out to Workshop pages, so deskless staff can pull up more information on their own phones, no company login required.

Give local leaders the tools to communicate well 

Managers and site leaders are often the most trusted messengers. In fact, HMH’s pulse surveys found that a team member’s direct leader is their number one source of truth. That’s why the team built “Leader List,” a short, skimmable, actionable email sent every Monday at 7 a.m. to supervisors and above.

Equipping leaders with clear, ready-to-use content (rather than expecting them to write it from scratch) keeps messaging consistent without slowing anyone down — and it works: HMH’s Leader List has climbed to an 83% open rate.

Treat internal comms as a culture function

At scale, comms is often the only thing connecting a nurse in one hospital to a colleague in another. Done well, it reinforces shared purpose across a distributed organization! For Rosanne’s team, that comes down to storytelling and “leading with heart.” Every newsletter leads with a human-interest feature of a real team member, from the security-guard-turned-beloved-pizza-chef to the nurse who saved a stranger’s life mid-shopping trip. As Rosanne said, the goal is to “put a face to those who live and embody our beliefs.”

PS — These principles apply whether you’re managing comms for 400 employees or 40,000! The difference at scale is how much intention and infrastructure it takes to keep them consistent. And for health systems specifically, how well that infrastructure accounts for a mostly frontline, always-on workforce.

Want the full story? Watch the recording

In the session, Rosanne Mottola, Internal Comms Strategist at Hackensack Meridian Health, joined the Workshop team to pull back the curtain on how HMH built an internal comms function from the ground up, and scaled it without losing the personal touch.

In the conversation, she covered:

• The cascading content model HMH uses to carry messaging across 18 hospitals without losing consistency
• Why consistency beats volume, and how HMH built systems around that philosophy
• How internal comms becomes the thread that connects culture across a large, distributed organization
• Her “three no’s” framework — the need-to-knows, want-to-knows, and nice-to-knows — for deciding what earns a spot in a newsletter
• A live Q&A covering everything from sourcing stories to digital signage, video, and working with HR

Watch the webinar recording!