About ACHE



For Immediate Release

American College of Healthcare Executives Announces Top Issues Confronting Hospitals: 2011

CHICAGO, January 26, 2012—Financial challenges again ranked No. 1 on the list of hospital CEOs' top concerns in 2011, making it their No. 1 concern for the last eight years, according to the American College of Healthcare Executives' (ACHE's) annual survey of top issues confronting hospitals. Healthcare reform implementation was again the No. 2 concern, as it has been since it was introduced to the survey in 2009. Patient safety and quality ranked third, edging out governmental mandates by a small margin.

“With healthcare reform still unfolding, it's not surprising that financial challenges, healthcare reform implementation and patient safety and quality are top of mind for CEOs,” says Thomas C. Dolan, PhD, FACHE, CAE, president and CEO of ACHE.

In the survey, ACHE asked respondents to rank 10 issues affecting their hospitals in order of importance and to identify specific areas of concern within each of those issues. Following are some key results from the survey, which was sent to 1,294 community hospital CEOs who are ACHE affiliates of whom 514, or 40 percent, responded. For 2011 the issues in the following table are listed by the average rank given to each issue, with the lowest numbers indicating the highest concerns.

Issue 20111,2 20103 20093
 Financial challenges 2.5 77% 76%
 Healthcare reform implementation4 4.5 53% 53%
 Patient safety and quality 4.6 31% 32%
 Governmental mandates 4.6 32% 30%
 Care for the uninsured 5.2 28% 37%
 Physician-hospital relations 5.3 30% 25%
 Patient satisfaction 5.6 16% 15%
 Technology 7.2 10% 7%
 Personnel shortages 7.4 11% 13%
 Creating an accountable care organization 8.4 --- ---
1In 2011 the average rank given to each issue was used to place issues in order of concern to hospital CEOs, with the lowest numbers indicating the highest concerns.
2 In 2011 the survey was confined to CEOs of community hospitals (nonfederal, short-term, nonspecialty hospitals).
3In 2010 and 2009, the percent of CEOs who named an issue among their top three concerns was used to place issues in order of concern to hospital CEOs.
4In 2009 this issue was referred to as “implications of healthcare reform.”


Within each of these 10 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.)


Financial Challenges (n=514)1
Medicaid reimbursement 88%
Government funding cuts 88%
Medicare reimbursement 78%
Bad debt 71%
Decreasing inpatient volume 54%
Increasing costs for staff, supplies, etc. 51%
Inadequate funding for capital improvements 43%
Managed care payments 38%
Other commercial insurance reimbursement 35%
Emergency Department 31%
Revenue cycle management (converting charges to cash) 28%
Competition from specialty hospitals 13%
Other n=34
1If number of respondents is fewer than 50, only numbers are provided.


Healthcare Reform Implementation (n=514)1
Reduce operating costs 67%
Alignment of provider and payor incentives 60%
Regulatory/legislative uncertainty affecting strategic planning 55%
Align with physicians more closely 54%
Develop information system integrated with primary care doctors 51%
Study avoidable readmissions to avoid penalties 45%
Obtain funding from the American Recovery and Reinvestment Act for electronic records 40%
Hire one or more primary care physicians 34%
Study avoidable infections to avoid penalties 25%
Other n=7
1If number of respondents is fewer than 50, only numbers are provided.


Patient Safety and Quality (n=514)1
Engaging physicians in improving the culture of quality 72%
Redesigning care processes 58%
Pay for performance 50%
Redesigning work environment to reduce errors 43%
Non-payment for “never” events 35%
Public reporting of outcomes data 31%
Medication errors 31%
Compliance with accrediting organizations e.g., JCAHO, NCQA 30%
Leapfrog demands (i.e., computerized physician order entry; ICU staffing by trained intensivists; and evidence-based hospital referral—moving patients to facilities that perform numerous surgeries and high-risk neonatal conditions) 29%
Nosocomial infections 21%
Other n=5
1If number of respondents is fewer than 50, only numbers are provided.

About the American College of Healthcare Executives

The American College of Healthcare Executives is an international professional society of more than 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE offers its prestigious FACHE® credential, signifying board certification in healthcare management. ACHE's established network of more than 80 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 goal of being the premier professional society for healthcare executives dedicated to improving healthcare delivery. 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 4,500 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.

Lisa M. Freund
Vice President
Communications and Marketing
American College of Healthcare Executives
One North Franklin, Suite 1700
Chicago, IL 60606
(312) 424-9420