Increases in costs and salaries have taken a toll on hospitals nationwide.

The Mayo Clinic is feeling the pinch, reporting a 36 percent income drop during 2015; the nation’s largest hospital system will end the fiscal year with its lowest cash level in 15 years.

And New York’s public hospital system, The Health and Hospitals Corp., has been labeled “not sustainable” by the city’s deputy comptroller.

So it is no surprise that for the fourth year in a row, finances topped hospital CEOs’ list of concerns in 2015, according to the American College of Hospital Executives’ annual survey of hospital CEOs. Hospital leaders focused most on these five financial concerns:

• Transitioning from volume-based care to value-based care payments
• Dealing with the adequacy and timeliness of Medicare payments
• Dealing with bad debt, including uncollectible charges from patients
• Increasing costs of staff and supplies
• Figuring out how to reduce operating costs

Following financial challenges, hospital leaders cited patient safety and providing quality care, governmental mandates and personnel shortages as top concerns.

Ways Hospitals Can Increase Profitability

Examine Reputation: Potential patients are selecting hospitals the way they would choose a restaurant or hotel, which means a hospital’s reputation can make or break someone’s decision to use your facility. To gauge the sentiment of the community, try conducting a community engagement survey.

You might find you need to improve customer service, your ER wait times are too lengthy or you need to revamp your billing and collections to create a more seamless payment process.

Improve Communication: Sixty-nine percent of accidental deaths and injuries in hospitals were caused by communication failures. These errors also contribute to nearly $12 billion in annual waste for hospitals.

You don’t have to invest in technologies to improve communication in your facility: Encouraging staff to ask questions can make a big difference. Asking questions can help improve understanding between clinicians during a patient handoff to a different department.

“In conversations between people of different positions, there is less shared knowledge and typically less willingness on the part of the lower-status person to ask questions,” reports Becker’s Hospital Review.

To ensure patient safety and optimal communication, clinicians should confirm key pieces of information about the patient and ask about the most critical treatment issues.

Hospital executives all face financial burdens, staffing challenges, government mandates and patient safety issues. But executives can tackle these issues by examining their hospital’s reputation and taking steps to improve communication.