Top Issues Confronting Hospitals: 2008
View the 2008 Top Issues press release.
Financial challenges continued to rank No. 1 on the list of
hospital CEOs’ top concerns in 2008, with patient safety and quality their second most
prominent concerns, according to the American College of Healthcare Executives’
(ACHE) annual survey of top issues confronting hospital CEOs. “While CEOs’ concerns
surrounding financial challenges are heightened, given the economic downturn, their
commitment to creating and implementing systems to improve quality and patient
safety in our nation’s hospitals is their second most prominent concern,” says Thomas
C. Dolan, PhD, FACHE, CAE, president and CEO of ACHE.
In the survey, ACHE asked respondents to rank 12 issues affecting their hospital in
order of importance and to identify specific areas of concern within their top three
issues. Following are some key results from the survey, which was sent to 1,092
hospital CEOs in October 2008 of whom 433, or 40 percent, responded.
Each of the issues in the following table is listed by the percentage of respondents who indicated it as one of the top three issues confronting their hospital. In 2008, 77 percent of respondents cited financial challenges as one of their top three concerns, reflecting an increase from 70 percent in 2007. Forty-three percent of hospital CEOs identified patient safety and quality as a major concern. In prior years these issues were listed separately, so no direct comparison is possible.
Care for the uninsured continues to rank as hospital CEOs’ No. 3 issue, with 41 percent of respondents citing it as a major concern. In 2008 there was increased mention by
respondents of governmental mandates (26 percent), patient satisfaction (22 percent)
and capacity issues (16 percent) as other top concerns.
| Issue |
2008 |
2007 |
2006 |
| Financial challenges |
77% |
70% |
72% |
| Patient safety and quality |
43% |
NA |
NA |
| Care for the uninsured |
41% |
38% |
37% |
| Physician/hospital relations |
32% |
35% |
40% |
| Personnel shortages |
30% |
30% |
30% |
| Governmental mandates |
26% |
22% |
23% |
| Patient satisfaction |
22% |
17% |
16% |
| Capacity |
16% |
11% |
11% |
| Technology |
9% |
8% |
8% |
| Issues about not-for-profit status |
2% |
4% |
3% |
| Malpractice insurance |
2% |
2% |
2% |
| Disaster preparedness |
1% |
1% |
12% |
| Patient safety |
NA |
29% |
27% |
| Quality |
NA |
33% |
29% |
Within each of their three top issues, respondents identified specific concerns facing their hospital. Following are those concerns in order of importance for the top three issues identified in the survey:
Financial Challenges
| Medicaid reimbursement |
83% |
| Bad debt |
78% |
| Increasing costs for staff, supplies, etc. |
75% |
| Medicare reimbursement |
73% |
| Inadequate funding for capital improvements |
63% |
| Managed care payments |
46% |
| Other commercial insurance reimbursement |
40% |
| Revenue cycle management |
40% |
| Emergency Department |
36% |
| Competition from specialty hospitals |
20% |
| Other |
9% |
Patient Safety and Quality
| Redesigning care processes |
66% |
| Redesigning work environment to reduce errors |
66% |
| Compliance with accrediting organizations |
60% |
| Medication errors |
57% |
| Nosocomial infections |
47% |
| Nonpayment for “never events” |
43% |
| Pay for performance |
41% |
| Leapfrog demands |
40% |
| Public reporting of outcomes data |
40% |
| Surgical mistakes |
24% |
| Other |
7% |
Care for the Uninsured
| Medicaid |
87% |
| Advocacy for funding |
75% |
| Underwriting costs |
61% |
| Reaching out to all community members |
27% |
| Other |
20% |
| Response to other hospital closings |
10% |
