While financial issues remained the uppermost
concern for hospital CEOs in 2007, concerns related to quality and patient safety
continue to gain prominence. According to Thomas C. Dolan, PhD, FACHE, CAE,
president and chief executive officer, American College of Healthcare Executives,
“Creating, implementing and monitoring the systems to improve quality and patient
safety has become a major focus of hospital CEOs. No longer treated as a delegated
responsibility solely for clinicians, the entire hospital team—senior management,
physician leaders and the board—are now actively working together to improve care.”
In its annual survey of top issues confronting hospital CEOs, the American College of
Healthcare Executives (ACHE) asked respondents to rank the three most pressing
issues affecting their hospital and identify specific areas of concern. Following are
results from the survey, which was sent on Sept. 28, 2007, to 1,080 hospital CEOs, 390
(36 percent) of whom responded.
I. Top Issues Confronting Hospitals
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. Financial
challenges exceeded other issues as hospital CEOs’ No. 1 issue.
This year, 70 percent of respondents cited financial challenges as one of their top three
concerns, compared to 72% in 2006 and 67% in 2005.
The greatest change occurred in those including quality and patient safety among their
top three concerns. Quality was included by 33%, increasing from 23% in 2005.
Similarly, concerns with patient safety as a top three issue increased to 29% from 20%
in 2005.
Care for the uninsured continues to rank as a top-three issue, with 38 percent of
respondents citing it as a major concern. While physician/hospital relations rounds out
the top-three concerns, it has declined slightly, being mentioned by 35% of respondents
compared to 40% last year.
Issue
2005
2006
2007
Financial challenges
67%
72%
70%
Care for the uninsured
35%
37%
38%
Physician/hospital relations
33%
40%
35%
Quality
23%
29%
33%
Personnel shortages
36%
30%
30%
Patient safety
20%
27%
29%
Governmental mandates
16%
23%
22%
Patient satisfaction
18%
16%
17%
Capacity
17%
11%
11%
II. Specific Concerns Within the Top Issues
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
Increasing costs for staff, supplies, etc.
74%
Medicaid
74%
Bad debt
73%
Medicare
71%
Inadequate funding for capital improvements
62%
Managed care payments
48%
Revenue cycle management
38%
Emergency Department
37%
Other commercial insurance
25%
Care for the Uninsured
Medicaid
82%
Underwriting costs
82%
Advocacy for funding
71%
Reaching out to all community members
28%
Response to other hospital closings
15%
Physician/Hospital Relations
Creating win-win collaborations
86%
Physician requests for payment for service to the hospital
83%
Competition with physician-owned facilities/equipment
