With acute labor shortages, cyberattacks, increasing denials from insurance payers, and cancelled elective surgeries, healthcare institutions have faced immense challenges in the aftermath of COVID-19. As a result, hospital investment offices have been met with unique, sizable, and volatile demands in areas like budgets and objectives to subsidize hospital operations, while still aiming to produce strong returns. In the face of continued pressures, how are hospital and health-care investment offices adapting to serve the needs of their institutions? In what ways have oversight bodies and committees responded to recent challenges? How are investment offices changing structures, technologies, allocations, and pools to meet these new needs? And how can allocators effectively utilize the right mix of internal and external resources for the best possible long-term outcome?