Hospital CEOs' No. 1 concern is staffing for 1st time in 17 years

Hospital CEOs ranked personnel shortages as their No. 1 concern in 2021. Financial challenges, which consistently held the top spot since 2004, were listed the second-most pressing concern in the American College of Healthcare Executives' annual survey

Here are the 10 most concerning issues hospital CEOs ranked in 2021:

  1. Personnel shortages of all types, including physicians 
  2. Financial challenges 
  3. Patient safety and quality 
  4. Behavioral health and addiction issues 
  5. Governmental mandates
  6. Access to care 
  7. Patient satisfaction 
  8. Physician-hospital relations 
  9. Technology 
  10. Population health management 
  11. Reorganization (mergers and acquisitions, partnerships, and restructuring) 

Most CEOs (94 percent) ranked a deficit of registered nurses as the most pressing within the category of personnel shortages, with technicians (85 percent), therapists (67 percent), primary care physicians (45 percent), physician specialists (43 percent) and physician extenders (31 percent) following. 

Most CEOs (87 percent) ranked increasing costs for staff and supplies as the most pressing within the category of financial challenges, with operating costs (53 percent), Medicaid reimbursement (52 percent), managed care and commercial reimbursement (44 percent), bad debt (39 percent), competition from other providers (39 percent), government funding cuts outside of Medicaid or Medicare (39 percent), Medicare reimbursement (39 percent) and the transition from volume to value (39 percent) following. 

Within financial challenges, CEOs are less concerned about price transparency, emergency department overuse and moving away from fee-for-service. 

Most CEOs (45 percent) ranked high prices and insufficient reimbursement for medications as the most pressing within the category of patient safety and quality, with physician engagement (44 percent), care redesign (44 percent), public reporting of outcomes (39 percent) and patient engagement (39 percent) following. 

Within patient safety and quality, CEOs are less concerned about pay for performance, medication errors and medication shortages. 

The survey was administered to CEOs of community hospitals (non-federal, short-term, non-specialty hospitals). ACHE asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are. Results are based on responses from 310 executives. 



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