Industry Survey HealthLeaders Media 2009

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For more analysis and a look at the complete survey results from all sectors, please visit our HealthLeaders Media Industry Survey 2009 Web page, which features downloadable reports covering CEOs, finance, technology, quality, marketing, health plan, physician, and community and rural leaders.

The HealthLeaders Media Industry Survey 2009 report is based on seven concurrent surveys sent to healthcare leaders in seven segments across the industry: CEO, finance, technology, physician, health plan, marketing, and quality leaders. In addition, data has been extracted based on community and rural status. The surveys included some common questions for all respondents, as well as some questions directed to leaders in specific segments. Percentages in the charts in this report have been rounded.

A total of 1,148 print and electronic surveys were completed in September and October 2008. The sample size allows for a 3% margin of error.

For more analysis of the survey results, go to

What are healthcare's most critical priorities in the coming years? What are the biggest drivers of costs? Where are the opportunities for growth? HealthLeaders Media's annual survey of senior leaders in multiple sectors of the industry shows the answers to those questions aren't always what you expect.

The almighty dollar may not be quite so almighty, after all. Senior executives across all sectors of the HealthLeaders Media Industry Survey 2009—leadership, finance, technology, marketing, quality, physicians, and health plans—agreed that quality and patient safety is their top priority for the next three years, with physician recruitment finishing second. Neither of those is necessarily surprising; providing safe, effective care to patients is healthcare's ultimate goal, and senior leaders know that doctors can directly impact a healthcare organization's revenue stream.

What is unexpected, however, is that consumer satisfaction ranked third while construction and capital improvements came in as executives' No. 4 priority. What of financial concerns like reimbursement, reducing costs, or revenue cycle? Those three issues ranked No. 5, No. 6, and No. 7, respectively. Perhaps the healthcare industry is finally taking a page from other service industries and placing more of an emphasis on the consumer experience. Or perhaps an issue like consumer satisfaction outranked a metric like reimbursement for an altogether different reason: It's at least something an organization can control.

"Hospitals often cannot do a lot about [reimbursement]," says Paul Ginsburg, president of the Center for Studying Health System Change. If a hospital's payer mix is poor, Ginsburg says, there isn't much the organization can do aside from moving to a more affluent suburban locale. The relatively low ranking of reimbursement and cost reduction could also reflect that many hospitals are in a relatively strong position when it comes to negotiating with insurers, Ginsburg says. "These issues do not have the priority of quality and safety, which has potential for a major impact on a hospital long term, and physician recruitment, which is always important for hospitals."

Most sectors—CEOs, CFOs, CIOs, physicians, and marketing leaders—agreed that physician recruitment and retention represents the No. 2 priority, but quality leaders ranked consumer satisfaction at No. 2 while health plan leaders saw cost reduction as the second-highest priority. And while consumer satisfaction placed third overall, it's worth noting that it lagged behind reimbursement, revenue cycle, cost reduction, and capital improvements for No. 1 votes. What's more, there was variation in the No. 3 slot within specific sectors. CEOs and CFOs chose reimbursement; technology, physician, health plan, and marketing leaders picked consumer satisfaction; and quality leaders ranked construction/capital improvements third.

Tom Dolan, CEO of the American College of Healthcare Executives, was pleased to see quality at the top, but says that he would have ranked nurse/staff retention and recruitment, which ranked eighth overall, higher on the list. "You can't create a nurse overnight," he says.

The least important priority? Almost across the board, senior healthcare leaders picked transparency; only chief marketing officers (who ranked it second to last) and health plan executives (who ranked it the fifth-highest priority) didn't place transparency in the bottom slot. Transparency is about public relations, says Ginsburg. "I don't think that institutions think there will be many effects of what they do, but that [transparency] is something that they simply have to do."

What's behind rising costs?
Senior leaders were also in agreement, across all sectors, that government laws and mandates represent the top driver of healthcare costs and that hospital errors ranked lowest among the top drivers of healthcare costs. The second- and third-biggest drivers across the pillars were labor costs and clinical technology, respectively.

Dolan says he would have placed labor at the top, "because labor is more than 50% of your cost in any healthcare organization." Respondents in individual sectors see it a bit differently, as well. While most sectors ranked labor costs No. 2, physician leaders put it at No. 6 (behind clinical technology, malpractice litigation, health plan overhead, and pharmaceuticals), and health plan leaders put it next to last. Quality leaders pegged it at No. 4.

Service line growth
Cardiology was ranked by 22% of all healthcare leaders as the service line with the greatest potential to produce strong revenue growth in the next three years, followed by orthopedics (14%) and imaging (12%). Gerontology, oncology, and wellness/bariatric tied for fourth (9%).

CEOs shared the same top three service lines with the overall group. But there was variation among the specific sectors. Physicians ranked three services lines at the top, with cardiology, imaging, and orthopedics tied with 15.98% each. Marketing leaders say orthopedics has the greatest potential (20.69%) with cardio and oncology tied for second (14.94%). And health plan leaders see gerontology as the top growth service line (26.09%).

"One thing that stands out to me on this [list] was gerontology," which tied for fourth overall with 9%, says Ginsburg. "That was a surprise. I thought that hospitals don't make a lot of money on those [patients], because they are covered by Medicare, which is not the best payer. Maybe they have thought of something that I haven't."

Job satisfaction
Healthcare leaders across all sectors were satisfied with their jobs; 45% said they were satisfied and 42% said they were very satisfied. Only 5% of healthcare executives were dissatisfied or very dissatisfied. CEOs were the most satisfied with 90.72% citing that they were satisfied or very satisfied. Next in the satisfaction rankings were quality leaders (88.98% satisfied or very satisfied), marketing (88.77%), CFOs (85.72%), physicians (85.11%), and health plan leaders (84.94%).

Dolan wasn't surprised that CEOs were the most content with their jobs. "The biggest determinant of job satisfaction is the ability to control your environment, and CEOs have the best ability to do that."

For the next HealthLeaders magazine story in this package, visit For complete, detailed survey results, visit

Carrie Vaughan

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