Dive Brief:

• Staffing shortages were the No. 1 concern confronting hospital CEOs in 2021, followed by financial challenges and patient safety and quality issues, according to an annual survey from the American College of Healthcare Executives.
• This is the first time since 2004 that financial challenges fell out of the top spot. Health systems continue grappling with widespread burnout and turnover two years into the pandemic, the study found.
• Other concerns listed by hospital CEOs in the survey included behavioral health and addiction issues, government mandates and access to care.

Dive Insight:

Hospitals continue to deal with some of the same challenges they faced at the start of the pandemic, even as some concerns now are more acute such as staffing.

In early January, a quarter of U.S. hospitals reporting their data to the HHS said they faced critical staffing shortages, according to the agency.

While earlier shortages were characterized by staff calling in sick and school closures, stress and burnout now are leading to rising turnover with many healthcare staff at their breaking points.

ACHE's survey includes responses from 310 community hospital CEOs who are ACHE members.

"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," ACHE president Deborah Bowen said in a statement.

Increasing the pipeline of staff and organization-level efforts to boost retention are long-term solutions to staffing challenges, Bowen added.

Still, systems can take some immediate steps like supporting and developing all staff, building personnel resilience and exploring alternative models of care, she said.

Respondents listed specific concerns around personnel shortages, with the supply of available registered nurses ranking as the top issue followed by shortages of technicians and therapists.

Within financial challenges, hospital CEOs are concerned about increasing costs for staff and supplies and reducing operating expenses. They're also worried about Medicaid reimbursement including adequacy and timeliness of payments, as well as managed care and other commercial insurance payments.

Other challenges include bad debt — such as uncollectible emergency department visits and other charges — as well as competition from other providers including ambulatory surgery centers and newer retail entrants, the survey found.

Related to patient safety concerns, CEOs said two top worries are high prices and insufficient reimbursement for medications. They also listed engaging physicians in improving culture, quality and safety as challenges, according to the report.