Top Issues Confronting Hospitals

Learn what the top challenges confronting U.S. community hospitals are, based on ACHE's annual survey.


ACHE's most recent Top Issues Confronting Hospitals Survey identified the following top challenges for hospitals in 2023

Top Issues 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

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.

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