If you were to ask hospital CEOs what issues keep them up at night, the scope of answers would be as varied as the types of hospitals and health systems out there. The challenges facing rural hospitals differ from those in urban settings, and large-scale systems have a variety of challenges not faced by standalone hospitals, and vice versa. But, overall, patterns would emerge.

That’s what makes the American College of Healthcare Executives’ (ACHE) annual survey of top issues confronting hospitals so interesting. As a community, we’re in this game together, and understanding these challenges is one key to delivering appropriate design solutions.

Of the top 11 CEO concerns outlined in the ACHE survey, almost all can be positively or negatively affected by the design of the built environment, from location of community outreach centers to technology that allows care to move into less traditional healthcare environments, like the home and workplace.

Not surprisingly, the issue of most concern for the 388 CEOs surveyed was financial challenges: it’s been ranked first in the survey for the past decade. With the industry shift to a pay-for-performance model and the changes happening with reimbursement, this topic continues to take center stage. Looking at the subcategories that fall under financial challenges, 39 percent of respondents specifically mentioned inadequate funding for capital improvements, clearly foretelling at least another year of reduced or scaled back new building projects.

Second on the list of concerns, is healthcare reform implementation. Four of the subcategories under this issue directly map back to the built environment, including reducing operating cost, understanding how to avoid readmissions, moving to electronic medical records, and preventing avoidable infections. Tied with governmental mandates for third place is the issue of patient safety and quality, one of the areas that can be most directly impacted by design.

More than half of its subcategories have known studies linking design to improved outcomes, like reducing healthcare associated infections, preventing never events and medication errors, redesigning the care process, and engaging physicians in improving quality. (Visit The Center for Health Design’s Knowledge Repository for papers on these topics at www.healthdesign.org/search/articles.)

At the Healthcare Design Conference this past year, it was evident that many vendors are focusing on solutions to some of these top concerns. The exhibit hall showcased products designed specifically to reduce noise; facilitate communication between caregivers as well as between caregivers, patients and their families; and stop the spread of infection and reduce falls and medication errors.

Clearly, the design community has been listening. But I’d be curious to know how many of the 388 CEOs who responded to this survey are aware of the great work being done to address their concerns. My gut feeling is that it might only be a few; with so many concerns keeping them up at night, it’s likely not a realistic expectation that they’d be familiar with the growing body of research, products, and design solutions.

Maybe one approach would be to have a “bring your client to conference” year. Hospital CEOs and design professionals could together attend the Healthcare Design Conference in San Diego this November. Rather than take a divide-and-conquer approach, teams could explore the exhibit hall, comb through the hundreds of presentations in advance and select a few that focus on key research or innovative case studies, or attend one of the local facility tours. The conference is a great jumping-off point for myriad conversations that could spark creative new solutions for your joint projects. And, you would have a set of new, shared experiences to reference in your work together.