Attributes of turnaround rural hospitals: Case study findings and research opportunities

Background: Rural and Critical Access Hospitals (CAHs) have a history of operating challenges and closure-conversion threats. The history is reviewed including the supportive public policy provisions and administrative tactics designed to maintain a community’s hospital as the hub and access point for health services. Limited research indicates that rural facilities are not strategic in their responses to challenges. A question emerges regarding the enduring nature of operating difficulties for these facilities, i.e., no understanding with explanatory value.Objective: The author, as the CEO in six rural hospitals designated as turnaround facilities, used inductive participant-observer involvement to identify operating attributes characteristic of these organizations. An objective description of each facility is provided. While implementing a turnaround intervention, fifteen behaviors or outcomes were found to be consistent across all six entities. This information is used to posit factors associated with or accounting for identified performance weaknesses.Conclusions: It is conceptualization that observed organizational behaviors can be explained as remnants of an agrarian ideology. Such a mindset is focused on preserving the status quo despite challenges that would require strategic positioning of the organization. In addition, emerging studies on community types indicates that follow-up research is needed that assesses the impact of community attributes on rural hospital performance. Also, this study shows that a theory of the rural hospital firm based on neo-classical economics has no explanatory value. Thus, a theory of the firm can be developed that includes behavioral economic principles.

From surviving to community benefit: A proposed rural health services research agenda

Background: The research history of rural hospitals from 1980 forward is reviewed. This summary, in turn, becomes a foundation for proposing an updated applied research agenda; one focused on ensuring health services for rural America. Research history: From 1980 to 1997 rural hospitals closed at a disproportionally higher rate than non-rural facilities. This trend prompted an academic search (Phase I) for the factors associated with the closure-conversion threat to hospitals. The public policy response was the Balanced Budget Act of 1997 and the creation of the Critical Access Hospital (CAH). Once the closure-conversion threat diminished as a result, the research focus (Phase II) shifted from survival to financial performance monitoring, economic efficiency, quality of care, and patient safety of CAHs. Phase II research demonstrates that CAHs can sustain themselves and are not necessarily victims of adverse rural circumstances. Today, CAHs, Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) exist as an established rural health safety net. Also, the 1332 CAHs are considered the hub of health services for rural communities. Significance: The rural environment remains a changing, challenging arena in which to ensure care for it residents. As such, the expanded Internal Revenue Service (IRS) definition of Community Benefit, specifically the periodic Community Health Needs Assessment (CHNA), provides a template for assessing the rural health safety net’s capacity to meet local health needs and improve the health status of its communities. This rubric also balances fiscal stewardship with positive health service outcomes. It is argued that the CHNA expansion of Community Benefit is an ideal research template and performance standard for all rural hospitals. It enables one to offer researched answers to the enduring question, “What is the best way to ensure health services for rural America?”