Previous Top Issues Reports
View convenient summaries of Top Issues Confronting Hospitals results from the last five years.
ACHE's most recent Top Issues Confronting Hospitals Survey identified the following top challenges for hospitals in 2023
Workforce challenges topped the list of hospital CEOs’ concerns in 2023, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals.
This survey, sent in fall 2023 to community hospital CEOs who are ACHE members, asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are, and to identify specific concerns within each of those issues. The survey was sent to 1,285 community hospital CEOs, of whom 241, or 19%, responded. The issues cited by survey respondents are those of immediate concern and do not necessarily reflect ongoing hospital priorities.
For a second year, respondents cited workforce challenges, which includes personnel shortages, as their top concern, giving it an average rank of 2.3 on an 11-point scale. Financial challenges ranked second for the third year in a row with an average rank of 2.6. Behavioral health/addiction issues ranked third with an average rank of 5.3. The survey results are shown below.
ACHE thanks the CEOs who responded to this survey for their time, consideration, and service to their profession and to healthcare leadership research.
| Issue | 2023 | 2022 | 2021 |
|---|---|---|---|
| Workforce challenges (e.g., personnel shortages) | 2.3 | 1.8 | --- |
| Financial challenges | 2.6 | 2.8 | 4.1 |
| Behavioral health/addiction issues | 5.3 | 5.2 | 5.4 |
| Access to care | 5.6 | 6.0 | 5.7 |
| Governmental mandates | 5.7 | 5.9 | 5.4 |
| Patient safety and quality | 5.9 | 5.9 | 5.0 |
| Patient satisfaction | 6.4 | 6.6 | 6.1 |
| Technology | 7.3 | 7.7 | 8.1 |
| Physician-hospital relations | 7.6 | 7.6 | 7.8 |
| Population health management | 8.7 | 8.6 | 8.4 |
| Reorganization (e.g., mergers, acquisitions, restructuring, partnerships) | 9.3 | 8.7 | 9.4 |
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The average rank given to each issue was used to place the issue in order of how pressing it is to hospital CEOs, with the lowest numbers indicating the highest concerns. The survey was confined to CEOs of community hospitals (nonfederal, short-term, nonspecialty hospitals). The survey was not conducted in 2020 due to the pandemic. |
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Specific Concerns Within the Top Issues
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 = 228) |
|---|---|
| Shortages of technicians (e.g., medical technicians, lab technicians) | 87% |
| Shortages of registered nurses | 86% |
| Burnout among non-physician staff | 79% |
| Shortages of physician specialists | 71% |
| Shortages of therapists (e.g., physical therapists, respiratory therapists) | 68% |
| Shortages of primary care physicians | 65% |
| Shortages of advanced practice professionals | 32% |
| Managing remote staff | 27% |
| Other | N = 11 |
| Financial Challenges | All respondents (N = 228) |
|---|---|
| Increasing costs for staff, supplies, etc. | 94% |
| Managed care and other commercial insurance payments | 66% |
| Medicaid reimbursement (including adequacy and timeliness of payment, etc.) | 61% |
| Reducing operating costs | 58% |
| Revenue cycle management (converting charges to cash) | 52% |
| Medicare reimbursement (including adequacy and timeliness of payment, etc.) | 51% |
| Inadequate funding for capital improvements | 50% |
| Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) | 46% |
| Bad debt (including uncollectable Emergency Department and other charges) | 45% |
| Competition from other providers (of any type — inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) | 36% |
| Transition from volume to value | 26% |
| Emergency Department overuse | 25% |
| Pricing and price transparency | 21% |
| Moving away from fee-for-service | 18% |
| Other | N = 11 |
| Behavioral health/addiction issues | All respondents (N = 229) |
|---|---|
| Lack of appropriate facilities/programs in community | 83% |
| Lack of funding for addressing behavioral health/addiction issues | 77% |
| Insufficient reimbursement specifically for behavioral health/addiction services | 72% |
| High volume of opioid addiction and related conditions | 45% |
| Overcoming societal judgment about mental health and substance abuse disorders | 34% |
| Legal/regulatory framework limiting treatment options | 29% |
| Other | N = 8 |