Executive Pressure Benchmark · October 2026
What Keeps Your Peers Up at Night?
Rank the issues that keep you awake, then see how your worry list compares with hospital CEOs and C-suite leaders across the country.
- Financial challenges ranked first
- 80% worry about threats to 340B
- 73% cite medical staff burnout
- 86% face physician recruitment limits
- CEO turnover up 32%
Why benchmark your worries
Every leader carries a private list of what could go wrong. The danger is not the list itself. It is the issue your peers see coming that never made your list.
This benchmark compares your priorities with the most recent national surveys of hospital CEOs, nurse leaders and health system executives, all fielded between August 2025 and March 2026.
What the country’s hospital leaders told us
2.2
mean rank for financial challenges among community hospital CEOs, first of 11 issues for another year
ACHE Top Issues survey, October 2025 (n=215)
80%
of CEOs cite threats to the 340B drug pricing program as a top governmental concern
ACHE Top Issues survey, October 2025
75%
name Medicaid reimbursement as a leading financial concern; 74% cite payers refusing to pay for services rendered
ACHE Top Issues survey, October 2025
73%
cite burnout among medical staff, and 73% cite technician shortages; 59% report burnout among hospital leaders
ACHE Top Issues survey, October 2025
86%
of hospital leaders point to physician recruitment constraints as a pressure shaping the decade ahead
FTI Consulting Hospital Operations Outlook, March 2026
57%
name cybersecurity and data privacy as their top technology concern, up from 49% a year earlier
FTI Consulting Hospital Operations Outlook, March 2026
80%
of health system and health plan executives say regulatory and policy factors will shape their 2026 strategy
Deloitte 2026 US Health Care Outlook (n=120)
+32%
rise in hospital CEO turnover in the first quarter of 2026 compared with the first quarter of 2025
Challenger, Gray & Christmas, via Becker’s, June 2026
The national ranking: 11 issues confronting hospitals
Community hospital CEOs ranked 11 issues in order of importance. A lower mean rank means a more pressing issue, so the longest bar is the biggest worry.
American College of Healthcare Executives, Top Issues Confronting Hospitals, survey of 1,185 community hospital CEOs fielded October 2025 (215 responses, 18%). Bar length = 12 minus mean rank.
Rank your worries
Put the 11 issues in the order they keep you up at night, with your biggest worry at the top. Use the arrows to move an issue. Your list starts in alphabetical order so it does not lead you toward the national answer.
- 1Access to care
- 2Behavioral health and addiction
- 3Financial challenges
- 4Governmental mandates
- 5Patient safety and quality
- 6Patient satisfaction
- 7Physician-hospital relations
- 8Population health management
- 9Reorganization and partnerships
- 10Technology
- 11Workforce challenges
Your peer alignment
Broadly aligned
Rank correlation with the national CEO order: 0.41
Possible blind spots
Issues peers rank in their top four that sit four or more places lower on your list.
Your distinctive priorities
Issues in your top three that peers rank four or more places lower. These may reflect your market, or a signal others have not seen yet.
You compared with your peers
Green dots show your rank and gray dots show the national CEO rank for each issue. Long connecting lines mark the biggest differences.
Inside the top three
Financial challenges, workforce challenges and governmental mandates topped the national ranking. Inside each, CEOs named the specific pressures behind the label. Mark yours to see where you match the field and which common concern you may be underweighting.
Concern overlap with peers
0 of 15
of the five most common national concerns in each category are on your list.
Financial challenges
Tap every concern that keeps you up at night. The percentage shows the share of CEOs nationally who cited it (n=213).
Select the concerns that apply to you.
Workforce challenges
Tap every concern that keeps you up at night. The percentage shows the share of CEOs nationally who cited it (n=204).
Select the concerns that apply to you.
Governmental mandates
Tap every concern that keeps you up at night. The percentage shows the share of CEOs nationally who cited it (n=211).
Select the concerns that apply to you.
American College of Healthcare Executives, Top Issues Confronting Hospitals, October 2025. Respondents could select multiple concerns in each category.
Across the C-suite
Each executive seat sees the same storm from a different window. Four national surveys show what operating, finance, strategy and nursing leaders are watching most closely.
Operations and the hospital floor
Pressures shaping the next decade
Share of hospital leaders citing each pressure.
FTI Consulting, Hospital Operations Outlook Survey, more than 200 leaders, March 2026.
Finance and payer strategy
Federal policy and Medicare Advantage
Share of healthcare executives reporting each expectation or action.
Forvis Mazars, Mindsets 2026 Healthcare Executive Leadership Report, 200 executives, March 2026.
Strategy and the board
Policy, uncertainty and AI maturity
Share of large health system and health plan C-suite executives.
Deloitte 2026 US Health Care Outlook Survey, 120 executives, fielded August to September 2025. Uncertain or neutral outlook rose from 28% a year earlier.
Nursing leadership
The single most pressing challenge
Share of nurse leaders naming each as their most challenging issue.
AONL Nursing Leadership Insight Study, 1,338 nurse leaders, September to October 2025 (n=1,019 for this item).
Leader load
The pressure is not only organizational. Nearly six in ten CEOs report burnout among hospital leaders, half worry about succession, and CEO exits are climbing. Take two minutes for an honest check on your own load.
Six questions for yourself
Work problems cost me sleep.
Crises consume the time I set aside for strategy.
I have seriously considered leaving my role in the past year.
A ready successor could step into my role tomorrow.
My board understands the pressures I am carrying.
I have a peer outside my organization I can talk to candidly.
Your reflection
Not yet answered
Answer all six questions to see your load reading.
This is a reflection prompt, not a validated burnout instrument. Bands are equal thirds of the possible score. If the questions surface something heavy, talk with a trusted colleague, coach or clinician; the people who lead others deserve support too.
The leadership exit wave
Becker’s Hospital Review tally of hospital and health system CEO exits: at least 180 in 2025 and at least 110 in 2026 through early June, about 40 of them retirements. Challenger, Gray & Christmas reported a 32% rise in Q1 2026.
Your 5-P agenda
A worry list becomes a leadership agenda when it is checked against peers, narrowed to what matters most, and assigned to people with a deadline.
Pinpoint
Name the issues that actually keep you up, before reading anyone else’s list.
- Rank all 11 issues on your own first
- Ask each executive to rank them separately
Prioritize
Compare with the national pattern and decide which gaps are real and which are local.
- Discuss every blind spot as a team
- Keep a distinctive priority only if your market data supports it
Partner
Match each top issue to the executive, board committee or outside partner best placed to move it.
- One accountable owner per issue
- Bring nursing and finance into the same room
Plan
Turn the top three into 90-day commitments with a measure the board will see.
- One leading indicator per issue
- Name the decision you need from the board
Prove
Re-rank every quarter and report how your list, and your results, have changed.
- Repeat this benchmark each quarter
- Retire worries you have resolved
Your agenda summary
Built from your ranking, the concerns you marked and your reflection. Paste it into a leadership team agenda or a board pre-read.
Methods
How the benchmark calculates
- National order sorts the 11 ACHE issues by their 2025 mean rank, from financial challenges (2.2) to reorganization (8.9).
- Peer alignment is the Spearman rank correlation between your order and the national order, rescaled from the range of minus 1 to 1 onto 0 to 100. A score of 100 means your order matches peers exactly; 50 means no relationship; 0 means the exact reverse.
- Alignment labels are descriptive quarters of the scale (80 and above closely aligned, 60 to 79 broadly aligned, 40 to 59 partly aligned, below 40 out of step). They are not validated thresholds.
- Blind spots are issues ranked in the national top four that you place four or more positions lower.
- Distinctive priorities are issues in your top three that peers place four or more positions lower.
- Concern overlap counts how many of the five most frequently cited sub-issues in each of the three leading categories you marked, out of 15. Ties at fifth place follow ACHE’s published order.
- Leader load scores six reflection items from 0 to 3, reversing the three protective items, for a total of 0 to 18 shown in equal thirds. It is a prompt for reflection, not a burnout measure.
Your answers stay in this browser. Nothing is sent, stored on a server or shared.
About the surveys
| Survey | Who | Fielded |
|---|---|---|
| ACHE Top Issues Confronting Hospitals | 215 community hospital CEOs (18% of 1,185) | October 2025 |
| FTI Consulting Hospital Operations Outlook | More than 200 hospital and system leaders | March 2026 |
| Forvis Mazars Mindsets 2026 | 200 executives across the continuum | Early 2026 |
| Deloitte US Health Care Outlook | 120 C-suite executives, systems and plans over $500M revenue | August to September 2025 |
| AONL Nursing Leadership Insight | 1,338 nurse leaders, 430 hospitals | September to October 2025 |
| Becker’s and Challenger CEO exits | Public CEO departures | 2025 to June 2026 |
Limits: each survey uses its own sample and wording, so results are shown side by side rather than combined. The ACHE ranking reflects community hospital CEOs and may differ from academic, rural or system leaders.
Sources
- American College of Healthcare Executives. Top Issues Confronting Hospitals: 2025. ache.org
- Becker’s Hospital Review. Hospital CEOs again cite financial, workforce challenges as top concerns. April 9, 2026. beckershospitalreview.com
- FTI Consulting. Survey: Majority of U.S. hospital leaders predict serious financial challenges in the near future. May 14, 2026. fticonsulting.com
- Forvis Mazars. Mindsets 2026 healthcare survey reveals financial performance a growing concern for executives. March 30, 2026. forvismazars.us
- Forvis Mazars. Mindsets 2026 Healthcare Executive Leadership Report. forvismazars.us
- Deloitte. 2026 US Health Care Executive Outlook. December 11, 2025. deloitte.com
- American Organization for Nursing Leadership. Nursing Leadership Insight Study, second generation, 2026. aonl.org
- Becker’s Hospital Review. What’s driving rising hospital CEO turnover in 2026? June 4, 2026. beckershospitalreview.com