Top Issues Confronting Hospitals: 2007

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	77%
Medical staff structures/leadership	59%
Niche providers	53%