June 30, 2019

I have been working in rural hospitals for virtually my entire career and have worked with the National Rural Health Association, MGMA, and AHA on rural healthcare issues. I have watched a number of rural hospitals close nation-wide with all of the hurt and hardship that occurs when this critical resource is removed from the community.

Almost without exception the demise of the local hospital is focused on Medicare, Medicaid, high cost of drugs, and lack of private insurance. We all know that these issues and entities are central drivers of problems within rural healthcare. However, as we focus on these issues, there is a tendency to paint the rural hospital as an innocent victim of big government and big business. Today, I would like to suggest that there is a local component as well. That local component is us: The Board and administration of these entities that are supposed to be leaders looking out for the best interests of the hospital, patients, and future. In a recent SWOT exercise, a young employee stood up and said “The biggest threat to our hospital is ourselves”. I think she is correct in this estimation and respectfully suggest that the Board and administration of all rural hospitals ask themselves many questions, including the following:

  • Are we truly leading this organization or are we following what the community say they want in their healthcare system?
  • Along with the above, are we providing services that are either poor quality and/or financially a drain on the organization because we “want to provide them”?
  • Along with one and two, are we keeping ourselves fully educated on rural healthcare issues to the point of being ready and able to proactively inform and educate those that we are leading?
  • Are we ignoring our prices and keeping them artificially low to give a “good deal” to our citizens?
  • Are we keeping taxes artificially low to appease the tax-payer?
  • Are we ignoring productivity/efficiency issues because we don’t want to lose an employee?
  • Are we employing more people than we need in order to provide jobs?
  • Are we keeping employees with performance issues because they are local?
  • Are we ignoring over-time issues because employees need the money?
  • Are we allowing employees and physicians to respond slowly or not at all while being paid for call duties?
  • Are we actively managing employees and physicians to adhere to organizational policies and procedures or allowing/enabling bad behavior because we don’t want to rock the boat?
  • Do we give away services to individuals who do not qualify for free services in order to “give people a break”?


These are just a few of the questions that you should ask and answer to assure that you truly are doing everything you can to assure your hospital can provide essential services into the future. If you can say yes, that you are maximizing your resources and have the data to back it up, it sends a powerful message when you visit your representatives in Washington D.C.