For Immediate Release
CHICAGO, Feb. 13, 2023 – Workforce challenges ranked No. 1 on the list of hospital CEOs’ top concerns in 2022, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals.
Workforce challenges is a category of concerns introduced to the survey in 2022 to better represent the multitude of workforce-related issues hospitals face. The category includes personnel shortages, which was hospital CEOs’ top-ranked issue in 2021, as well as staff burnout, among other workforce issues.
Financial challenges ranked second in the 2022 survey, and behavioral health/addiction issues ranked third.
This marks the second year in a row that workforce or personnel challenges has been the top-ranked issue. Before that, financial challenges ranked first in the survey for 16 consecutive years.
“Hospitals need to take both long- and short-term measures to address critical workforce issues so they can continue to provide safe, high-quality care now and in the future,” says Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE. “Longer-term solutions include strengthening the workforce pipeline through creative partnerships, such as those with colleges to grow the number of nurses and technicians. More immediate solutions include supporting and developing all staff, building staff resilience, organizing services to reflect the realities of the labor market and exploring alternative models of care.”
In the survey, ACHE asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are and to identify specific areas of concern within each of those issues. Following are some key results from the survey, which was sent to 1,321 community hospital CEOs who are ACHE members, of whom 281, or 21%, responded. The issues cited by survey respondents are those of immediate concern and do not necessarily reflect ongoing hospital priorities.
| Issue | 2022 | 2021 | 2019 |
|---|---|---|---|
| Workforce challenges (e.g., personnel shortages)1 | 1.8 | --- | --- |
| Financial challenges | 2.8 | 4.1 | 2.7 |
| Behavioral health/addiction issues | 5.2 | 5.4 | 5.0 |
| Patient safety and quality | 5.9 | 5.0 | 5.3 |
| Governmental mandates | 5.9 | 5.4 | 5.2 |
| Access to care | 6.0 | 5.7 | 5.9 |
| Patient satisfaction | 6.6 | 6.1 | 6.3 |
| Physician-hospital relations | 7.6 | 7.8 | 7.1 |
| Technology | 7.7 | 8.1 | 7.7 |
| Population health management | 8.6 | 8.4 | 8.1 |
| Reorganization (e.g., mergers, acquisitions, restructuring, partnerships) | 8.7 | 9.4 | 8.7 |
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The average rank given to each issue was used to place the issue in order of how pressing they are to hospital CEOs, with the lowest numbers indicating the highest concerns. The survey was confined to CEOs of community hospitals (nonfederal, short-term, non-specialty hospitals). 1 Workforce challenges, added to the survey in 2022, includes the challenge of personnel shortages. Personnel shortages ranked as the No. 1 challenge in 2021 with an average rank of 1.6, and as the No. 2 challenge in 2019 with an average rank of 4.6. |
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Within each of these 11 issues, respondents identified specific concerns facing their hospitals. Following are those concerns in order of mention for the top three issues identified in the survey. (Respondents could check as many as desired.)
| Workforce challenges (e.g., personnel shortages) | All respondents (N = 281) |
|---|---|
| Shortages of registered nurses | 90% |
| Shortages of technicians (e.g., medical technicians, lab technicians) | 83% |
| Burnout among non-physician staff | 80% |
| Shortages of therapists (e.g., physical therapists, respiratory therapists) | 70% |
| Shortages of physician specialists | 66% |
| Shortages of primary care physicians | 65% |
| Shortages of advanced practice professionals | 42% |
| Managing remote staff | 32% |
| Other | N = 46 |
| Financial Challenges | All respondents (N = 281) |
|---|---|
| Increasing costs for staff, supplies, etc. | 89% |
| Reducing operating costs | 66% |
| Medicaid reimbursement (including adequacy and timeliness of payment, etc.) | 63% |
| Managed care and other commercial insurance payments | 58% |
| Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) | 52% |
| Medicare reimbursement (including adequacy and timeliness of payment, etc.) | 51% |
| Competition from other providers (of any type — inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) | 46% |
| Revenue cycle management (converting charges to cash) | 43% |
| Inadequate funding for capital improvements | 41% |
| Bad debt (including uncollectable Emergency Department and other charges) | 38% |
| Transition from volume to value | 30% |
| Emergency Department overuse | 25% |
| Pricing and price transparency | 22% |
| Moving away from fee-for-service | 21% |
| Other | N = 26 |
| Behavioral health/addiction issues | All respondents (N = 281) |
|---|---|
| Lack of appropriate facilities/programs in community | 78% |
| Lack of funding for addressing behavioral health/addiction issues | 77% |
| Insufficient reimbursement specifically for behavioral health/addiction services | 70% |
| High volume of opioid addiction and related conditions | 51% |
| Legal/regulatory framework limiting treatment options | 30% |
| Overcoming societal judgment about mental health and substance abuse disorders | 29% |
| Other | N = 3 |
About the American College of Healthcare Executives
The American College of Healthcare Executives is an international professional society of more than 48,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE’s mission is to advance our members and healthcare management excellence. ACHE offers its prestigious FACHE® credential, signifying board certification in healthcare management. ACHE's established network of 76 chapters provides access to networking, education and career development at the local level. In addition, ACHE is known for its magazine, Healthcare Executive, and its career development and public policy programs. Through such efforts, ACHE works toward its vision of being the preeminent professional society for leaders dedicated to improving health. The Foundation of the American College of Healthcare Executives was established to further advance healthcare management excellence through education and research. The Foundation of ACHE is known for its educational programs—including the annual Congress on Healthcare Leadership, which draws more than 4,000 participants—and groundbreaking research. Its publishing division, Health Administration Press, is one of the largest publishers of books and journals on health services management including textbooks for college and university courses.
Contact:
Randy Liss
Director of Communications
Department of Communications and Marketing
American College of Healthcare Executives
300 S. Riverside Plaza, Suite 1900
Chicago, IL 60606
(312) 424-9417
rliss@ache.org