Nearly one-fourth of the country's hospital chief executive officers resigned their posts last year, health care officials said, warning that the growing exodus could hurt the quality of patient care.

"Hospitals do not do very well when they are leaderless and ultimately that can affect the care to patients," Alexander Williams, III, senior vice president of the Chicago-based American Hospital Association, said last week.In 1981-82, 16.9 percent of hospital chief executives left their positions, said the study by the AHA, the American College of Healthcare Executives and Heldrick and Struggles, an executive search consulting firm.

But in 1986-87 the number grew to 24.2 percent, the survey said.

The turnover rate at the 5,526 hospitals surveyed increased an average of 4.5 percent per year over the six years covered by the study.

Facilities with financial difficulties had a greater percentage of chief executives leaving, said Stuart Wesbury Jr., president of the American College of Healthcare Executives.

Williams, Wesbury and Michael Caver, a partner in the consulting firm, gave no reason for the increase in departures, saying that would be the subject of the second phase of their study.

But former hospital chiefs said the reason usually is money.

"The expectations upon the administrators and the CEOs have increased, especially in the area of financial operation," said Carl Fitch, president and chief executive officer of Holy Cross Health Services of Utah, which oversees three hospitals in the state.

About 40 percent of chief executives who left before finishing their fifth year on the job took CEO jobs at other hospitals. Of those who worked longer than 41/2 years, 33 percent took top jobs at other hospitals, the study said.

The lowest turnover was reported among hospitals with fewer than 200 beds that are part of a group of hospitals, Williams said. He said hospitals with the highest turnover rates were in large cities, suburbs and rural areas of the South and West.

Fitch recently resigned as chief executive of a hospital in the Southwest because of the challenge of joining the Utah health services firm. But he said his case was not typical.

"Usually, either the administrator sees the financial demands are too much or he realizes he can't deal with them," Fitch said in an interview from his Salt Lake office. "In some cases, he voluntarily leaves or he may be asked to leave.

"The pressures are great. It is costing more to operate and with the government paying less on Medicare, the income is diminishing so there's not enough money to reinvest in the facility," he said.

"That can affect care because there may not be enough money for equipment or employees, such as nurses and therapists, who deal with patients."

Christopher Clark, chief executive of Northside Hospital in Atlanta for 17 years before leaving this year to become a health care consultant, agreed.

"Employees want higher wages, trustees want to turn a profit, the medical staff needs money for equipment and insurance companies and the government want lower rates," he said. "The CEO is caught in the middle."