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CHICAGO, February 4, 2022—Personnel shortages ranked No. 1 on the list of hospital CEOs’ top concerns in 2021, according to the American College of Healthcare Executives’ annual survey of top issues confronting hospitals. Financial challenges, which had led the rankings since 2004, was listed second. Patient safety and quality ranked third.
“This is the first time since 2004 that financial challenges has moved from the most significant challenge to the second position. Both long- and short-term solutions are needed to address the shortages in critical front-line staff shown in our study to ensure hospitals have workforces that can meet the demands for safe, high-quality care both today and in the future,” says Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE. “Longer term solutions include increasing the pipeline of staff to these positions, as well as organization-level efforts to increase staff retention. More immediate solutions include supporting and developing all staff, building staff resilience and exploring alternative models of care.
In the survey, ACHE asked respondents to rank 11 issues affecting their hospitals in order of how pressing they are and to identify specific areas of concern within each of those issues. Following are some key results from the survey, which was sent to 1,327 community hospital CEOs who are ACHE members, of whom 310, or 23%, responded. The issues cited by survey respondents are those of immediate concern and do not necessarily reflect ongoing hospital priorities.
|
Issue |
2021 |
2019 |
2018 |
|
Personnel shortages (all types, including physicians) |
1.6 |
4.6 |
5.2 |
|
Financial challenges |
4.1 |
2.7 |
2.8 |
|
Patient safety and quality |
5.0 |
5.3 |
5.1 |
|
Behavioral health/addiction issues |
5.4 |
5.0 |
5.3 |
|
Governmental mandates |
5.4 |
5.2 |
5.1 |
|
Access to care |
5.7 |
5.9 |
6.2 |
|
Patient satisfaction |
6.1 |
6.3 |
6.1 |
|
Physician-hospital relations |
7.8 |
7.1 |
6.6 |
|
Technology |
8.1 |
7.7 |
7.7 |
|
Population health management |
8.4 |
8.1 |
8.1 |
|
Reorganization (e.g., mergers, acquisitions, restructuring, partnerships) |
9.4 |
8.7 |
8.3 |
|
The average rank given to each issue was used to place the issue in order of how pressing they are to hospital CEOs, with the lowest numbers indicating the highest concerns. |
|||
|
Personnel shortages (n=310) |
|
|
Registered nurses |
94% |
|
Technicians (e.g., medical technicians, lab technicians) |
85% |
|
Therapists (e.g., physical therapists, respiratory therapists) |
67% |
|
Primary care physicians |
45% |
|
Physician specialists |
43% |
|
Physician extenders and specially certified nurses (physician assistants, nurse practitioners, certified nurse midwives, etc.) |
31% |
|
Other |
N=52 |
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.)
|
Financial Challenges (n=310) |
|
|
Increasing costs for staff, supplies, etc. |
87% |
|
Reducing operating costs |
53% |
|
Medicaid reimbursement (including adequacy and timeliness of payment, etc.) |
52% |
|
Managed care and other commercial insurance payments |
44% |
|
Bad debt (including uncollectable Emergency Department and other charges |
39% |
|
Competition from other providers (of any type—inpatient, outpatient, ambulatory care, diagnostic, retail, etc.) |
39% |
|
Government funding cuts (other than reduced reimbursement for Medicaid or Medicare) |
39% |
|
Medicare reimbursement (including adequacy and timeliness of payment, etc.) |
39% |
|
Transition from volume to value |
39% |
|
Inadequate funding for capital improvements |
35% |
|
Revenue cycle management (converting charges to cash) |
32% |
|
Pricing and price transparency |
29% |
|
Emergency Department overuse |
26% |
|
Moving away from fee-for-service |
25% |
|
Other |
N=11 |
|
Patient safety and quality (n=310) |
|
|
High price/insufficient reimbursement for medications |
45% |
|
Engaging physicians in improving the culture of quality/safety |
44% |
|
Redesigning care processes |
44% |
|
Public reporting of outcomes data (including being transparent, fairness of measures, reporting burden) |
39% |
|
Patient engagement in treatment |
39% |
|
Engaging physicians in reducing clinically unnecessary tests and procedures |
37% |
|
Redesigning work environment to reduce errors |
33% |
|
Compliance with accrediting organizations (e.g., Joint Commission, NCQA) |
32% |
|
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 or treat high-risk neonatal conditions) |
28% |
|
Pay for performance |
27% |
|
Medication errors |
15% |
|
Lack of availability of medications |
14% |
|
Other |
N=13 |