The past two years have introduced new problems for hospital leaders to grapple with, while also intensifying old ones.
Becker's Hospital Review spoke with hospital CEOs and CFOs, and they said the following eight issues were the most pressing. Three leaders cited staffing as their top concern.
Editor's note: These answers have been edited lightly for clarity and brevity.
Provider engagement
Calvin Carey. CFO, Mt. San Rafael Hospital (Trinidad, Colo.)
Providers have the knowledge of what the patient is going through and what causes the patient the most concern. It’s the details that count, and the providers are the closest to the details. Providers are pulled by many competing alternatives. Those alternatives range from doing the same thing at another location, family/lifestyle, whether to stay in health care, or staying in health care but not patient care. Money is a concern but not the only concern.
Staffing
Demi Wilkinson. CFO, Northeast Montana Health Services (Wolf Point)
The biggest issue for our organization is staffing, especially licensed staffing. Trying to have enough personnel to avoid cutting any services and possibly to add services that address our community health needs assessment without overworking and burning out our current licensed personnel. As a critical access hospital and rural health clinic, it is especially vital to attract these licensed workers and attempt to retain them once they are in the community. Our organization works very diligently to grow our own personnel from the community but still runs into hurdles with education that needs to be completed in other communities. Once someone has left the community, it becomes more difficult to attract them to return.
Thomas Siemers. CEO, Wilbarger General Hospital (Vernon, Texas)
I think COVID-19 has changed the priorities for every hospital — urban or rural. The number one immediate issue for me is staffing. Where to find essential workers, how to keep them, how to pay for them. Skyrocketing salaries, shortage of key front-line team members (particularly RNs and respiratory therapists), and managing the expense of [medical transportation]. We’re fortunate in Texas (for now) because the state has provided transportation workers — but for how long? I'm not sure how we’ll be able to attract and retain these essential workers to work in rural Texas when this program goes away.
Richard Hart, MD. President and CEO, Loma Linda (Calif.) University Health
We have just completed and moved into a $1.3 billion hospital expansion. Current patient demand is filling our emergency department and patient rooms. The biggest limiting factor is staffing, both from the COVID-19 vaccine hesitancy and nurses retiring due to stress and workload. Though our own school of nursing helps to backfill that staffing demand, experienced nurses are critical and difficult to replace.
Unity in public policy advocacy
Brian Peters. CEO, Michigan Health & Hospital Association (Okemos)
For an association, it is imperative that our member hospitals and health systems remain united around our common mission, and advocate in unison for public policy that advances the health of individuals and communities.
Extrapolating lessons learned from the pandemic
Anthony Slonim, MD. President and CEO, Renown Health (Reno, Nev.)
With all the challenges presented by the pandemic and all the opportunities that lie ahead, I spend most of my time thinking about the resilience and resourcefulness of our healthcare heroes, how nimbly we pivoted to meet the needs of our communities, and how to apply those learnings to reinvent health and healthcare by doing things very differently. If we can move at lightning speed and with the creativity, commitment and dedication we brought to COVID-19 and use that to solve other health problems that still plague this country and our world, can you imagine how we might improve lives?
As a healthcare leader, a physician and a public health professional who has lived through this time in history, I feel it is a gift and a responsibility to serve others and to put bold, creative and innovative solutions in place to help people live their best lives. I have a lot of ideas.
Politicization
Mr. Peters:
I am concerned about the potential for increasing politicization of healthcare issues that should be nonpartisan.
Higher operating costs vs. infrastructure needs
Mr. Siemers:
We need a new facility. Our hospital is over 50 years old, with a crumbling infrastructure. On top of our infrastructure needs, COVID-19 expenses have driven up our operating costs significantly. We’ve initiated a number of new programs and services that are providing new revenue and optimism, but the ability to cover the debt service for a new facility is not feasible.
Revolutionary change
Dr. Slonim:
I am an optimistic person by nature. I see incremental improvement as a sign of hope, but I am looking to make a revolutionary change in our legacy systems. We must now transition from using a crisis response mentality in a pandemic to a new way of aligning to the health priorities affecting our communities. COVID-19 and other infectious diseases may always be with us, and we will need to manage them as we have done in the past. My biggest concern for 2023 is how the social determinants affecting a person’s health or a community’s health have worsened over the last 18 months. We still need to reduce health disparities, promote community wellness, improve care for vulnerable populations and meet health needs and gaps in services. I am putting my energy into connecting people to resources that improve health challenges in the community.
National market player consolidation
Dr. Hart:
The continued consolidation of national players in our marketplace is of potential concern. Developing the best affiliations and partnerships will dominate our planning over the next few years.