The No. 1 problem still keeping hospital CEOs up at night

Hospital CEOs ranked workforce challenges as their No. 1 concern in 2023. Financial challenges, which held the top spot for 16 consecutive years prior to 2021, were listed the second-most pressing concern in the American College of Healthcare Executives' annual survey. Behavioral health and addiction issues ranked third. 

This is the second consecutive year that hospital CEOs have ranked workforce challenges, financial challenges and behavioral health and addiction issues as the top three concerns, and the third consecutive year that workforce or personnel challenges have been the top-ranked issue.

Here are the 10 most concerning issues hospital CEOs ranked in 2023, along with their average score on an 11-point scale of how pressing CEOs find each issue.

  1. Workforce challenges (includes personnel shortages, as well as staff burnout, among other workforce issues) — 2.3 
  2. Financial challenges — 2.6
  3. Behavioral health and addiction issues — 5.3
  4. Access to care — 5.6
  5. Governmental mandates — 5.7
  6. Patient safety and quality — 5.9
  7. Patient satisfaction — 6.4
  8. Technology — 7.3
  9. Physician-hospital relations — 7.6 
  10. Population health management — 8.7 
  11. Reorganization (mergers and acquisitions, partnerships and restructuring) — 9.3

Within workforce challenges, 87% of CEOs ranked shortages of technicians (medical technicians, lab technicians) as the most pressing, followed by shortages of registered nurses (86%) and burnout among nonphysician staff (79%). 

Ninety-four percent of CEOs ranked increasing costs, including for staff and supplies, as most pressing within the category of financial challenges. That was followed by managed care and other commercial insurance payments (66%). 

The results are based on a survey sent in fall 2023 to CEOs of community hospitals (nonfederal, short-term, nonspecialty hospitals) who are ACHE members. ACHE asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are. Within each issue, CEOs identified specific concerns facing their hospitals and could choose as many as desired. Results are based on responses from 241 executives.

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