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Personnel shortages ranked No. 1 on the list of hospital CEOs’ top concerns in 2021, according to the American College of Healthcare Executives’ (ACHE) annual survey of top issues confronting hospitals.

Financial challenges, which had led the rankings since 2004, dropped to second, in the annual ACHE survey. Patient safety concerns ranked third.

“This is the first time since 2004 that financial challenges moved from the most significant challenge to the second position, said Deborah J. Bowen, FACHE, CAE, president and CEO of ACHE.

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.

The lack of available registered nurses ranked as the most pressing issue in the staff shortages category (94%) followed by shortages of medical and lab technicians (84%) and respiratory and physical therapists (67%).

“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,” Bowen said.

“Longer term solutions include increasing the pipeline of staff to these positions, as well as organization-level efforts to increase staff retention,” Bowen said. “More immediate solutions include supporting and developing all staff, building staff resilience and exploring alternative models of care.”

In the No. 2 financial challenges category, CEOs cited concerns about increasing costs for staff and supplies (87%), the need to reduce operating expenses (53%), and the timeliness of Medicaid reimbursements (52%).

Patient safety worries, which ranked third in the survey, identified concerns about the high cost of patient medications and insufficient reimbursement for medications (45%). The CEOs also cited the need to engage physicians in improving the culture of quality and safety (44%) at their hospitals.

Other top concerns listed by hospital CEOs in the survey included behavioral health and addiction issues, government mandates and access to care.

The survey was sent to 1,327 community hospital CEOs who are ACHE members, of whom 310, or 23%, responded.