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2007 HealthLeaders Annual CEO Survey

A high-altitude look at our annual survey of hospital and medical group chief executive officers shows a group of leaders who are generally happy about their jobs with no immediate plans to retire. But before they do eventually bow out, they have some money to spend.

The HealthLeaders Media Annual CEO survey drew responses from 382 leaders, with almost 58 percent coming from leaders of small hospitals of 100 beds or fewer, and another 26 percent coming from larger community hospitals. Those numbers jibe with a survey by the American Hospital Association that found 4,936 community hospitals out of 5,756 total hospitals nationwide.

We asked our CEOs to give us an age range, with almost exactly the same 38 percent falling between 46-55 and 56-65. Fewer than four percent of CEOs were older than 65. Longevity in the CEO role was fairly even, with 25 percent in their role less than two years, and another 25 percent for three to five years. More than 26 percent of CEOs have been in their roles more than 10 years. So while many industry surveys have pointed to a relatively high rate of CEO turnover, these results seem to suggest that while there is a percentage of CEOs who are in the under-two-years category, almost 50 percent of CEOs have been in place at least six years or longer.

As far as future plans, almost 43 percent of CEOs have no plans to retire in the next 10 years. Almost 58 percent of the CEO respondents are 55 and younger, so one might not expect them to be near retirement yet. When we filter the responses to those ages 55-65, 44 percent say they plan to retire in two to five years, and 43 percent will bow out in six to 10 years. Admittedly, age ranges are an imprecise methodology, but the overall suggestion is for a core team of leaders that plans to stay the course for a while.

The pressures of how a CEO spends his or her time are ever shifting, but the results show that the big three-physician relations, operations and strategic planning-still dominate the CEO's calendar. Somewhat surprising were the 33 percent of respondents who said they spend less than 10 percent of their time on staff and leadership development. It was also surprising to find that 68 percent of respondents spend less than 10 percent of their time on political and regulatory matters, given the growing weight that regulation has on the industry.

Performance bonuses are still dominated by those for financial performance, but a slight majority also receives bonuses for quality and patient safety. It will be worth benchmarking these numbers against future trends.

One of the most shocking responses was that only 23 percent of CEOs surveyed included the chief information officer on their inner circle leadership team. Perhaps that number reflects the large number of smaller hospitals surveyed that may not have a true CIO. But the telling answer is that in question 18, almost 86 percent of hospitals will either substantially or slightly increase their IT spending in the next five years. One has to wonder who is helping the CEO decide where to spend all that money.

As in business, healthcare is less about gaining new customers than it is about taking someone else's. More than 40 percent of CEOs say their top competitive threat remains loss of market share to other area hospitals, with a quarter of CEOs worried about the threat from specialty hospitals.

While the assumption may be that the problem of the uninsured is the consensus No. 1 challenge in healthcare, less than half of our CEO respondents-45 percent-ranked it as the top issue. More than 22 percent listed staffing shortages as a more urgent need. Regarding another industry trend, less than 15 percent of respondents are treating consumer-driven healthcare as a major market shift, with 61 percent putting a few initiatives in place.

Finally, the depth of pessimism about healthcare reform coming from the federal government was overwhelming. Even on matters that are largely regulatory-such as putting electronic medical record standards in place-opinions were overwhelmingly pessimistic that Washington will do anything substantial.

-Jim Molpus