The American College of Healthcare Executives conducts an annual survey of community hospitals to identify the top issues of immediate concern. Not surprisingly, the CEOs of these hospitals are most concerned with financial challenges. Patient safety and quality, governmental mandates, personnel shortages and patient satisfaction round out the top five issues.

The financial concerns are due, in most part, to CEOs having to carefully navigate through the challenges of transitioning from volume to value payment models (65 percent) and Medicaid reimbursement (62 percent). However, bad debt and increasing costs for staff, supplies and other operating expenses are also contributing to the struggle for financial balance.

In the category of patient safety and quality, the top three issues faced are:

  • engaging physicians in improving the culture of quality/safety (66 percent)
  • reducing clinically unnecessary tests and procedures (60 percent)
  • redesigning care processes (59 percent)

When it comes to governmental mandates, the top three issues faced are:

  • ICD-10 implementation (71 percent)
  • CMS audits (63 percent)
  • regulations (61 percent)

When looking at these rankings and considering the back stories, we begin to see how this collection of top issues is interrelated. Observant healthcare leaders will recognize that patient satisfaction, patient safety/quality and CMS paying for performance are directly tied to the top issue of financial challenges and concerns related to paying for value, which rewards or penalizes hospitals based upon their patient satisfaction and quality/safety metrics.

Hospitals and other providers will increasingly have a greater proportion of reimbursement placed at risk. Those with the best quality, safety and satisfaction metrics will be rewarded with financial incentives. Those who fall short and rank lowest in comparison with their peers will be financially penalized by CMS, and ultimately, other payors.

Healthcare leaders who understand the science see clearly that producing safe and quality care that meets or exceeds the expectations of their customer will lead to financial incentives rather than penalties. Standardizing care processes that are grounded in evidence-based medicine are at the core of this science.

The art for healthcare leaders comes into play as they create financial strategies that will get them through the transition to value-based models and engage and motivate physicians in the change that must take place. It starts with building trusting and mutually supportive relationships and partnering to discover and understand the "why" behind behaviors. The most successful will be capable of helping physicians understand the why and what it means to their practice, and as individuals.

Instead of seeing these issues in silos, effective healthcare leaders will take a broader view and recognize the interconnectedness of each for more effective strategies to overcome the challenges and sustain improvements. They will pull common threads together and weave transformational changes and sustainable improvements .

It is also noteworthy that personnel shortages jumped in the ranking from 10th in 2014 to fourth only one year later. This issue is most likely due to the graying of the population and workforce and the increases in staffing costs.

However, another contributing factor may be a sign of healthcare leaders re-evaluating the skill sets and competencies needed for the future of healthcare delivery — one of delivering on value instead of volume.