Rural hospital executives are all too familiar with the many challenges that result from geographic isolation. But now experts say these leaders should also be aware of isolation within their own facilitiesand be actively engaged in their communitiesif they want to run successful organizations.
From formal masters degree programs to yearlong fellowships to one-day seminars, there are a wide range of opportunities to help rural hospitals prepare strong leaders in the C-suite. And in each case, community is seen not just as a home to a rural hospital but also as a determinant in that hospitals success.
The out-of-date attitude: the chief executive officers only responsibility is to run the organization, says Tim Size, executive director of the Rural Wisconsin Health Cooperative. The current attitude: In addition to that, they have to be profoundly effective as a community leader to do what it takes to make a community healthy.
Rural hospital leaders should be actively engaged in their communities because the local hospital is often the areas leading economic driver, says Philip Stuart, CEO at Tomah (Wis.) Memorial Hospital, a 25-bed critical-access hospital. Stuart, who serves as chairman of the Rural Wisconsin Health Cooperative, says community involvement is also important for recruitment purposes. A thriving community with good schools and plenty of recreational activities can help attract physicians with families to move to a rural community.
We see rural hospitals focusing on both traditional health administration and community development, says Larry Gamm, director of the Master of Health Administration program at the Texas A&M Health Science Centers School of Rural Public Health. Typically, the (rural) hospital is the largest or second-largest employer, so there is a strong economic component for training rural health administrators, he says, adding that the schools programs emphasize working with community organizations and being involved with the local schools and the chamber of commerce.
Some rural hospitals will provide a school nurse or integrate their activities in the community. Our students not only hear that in the classroom, but a number of our faculty are involved in research and outreach projects here in the state, Gamm says.
The school also helped establish the Brazos Valley Health Partnership, in which organizations in seven south-central Texas counties work together to conduct a four-year community assessment and also develop county health resource centers. Students and faculty work on this project, as well as activities related to rural chronic-disease management and health information technology.
Forty-five students are enrolled in the two-year masters program in health administration at Texas A&M, which includes an introductory class on rural health systems, 18 total courses, and a 400-hour internship in the summer between the programs first and second years. About half of the programs students complete their internships in rural Texas settings, while the rest are placed in urban areas in Texas as well as other parts of the country. Currently, 12 of the programs 40 graduates are placed in rural areas, Gamm says.
A number of our students intern with rural hospitals where they see a wide variety of administrative activity, Gamm says. Others do a yearlong residency or fellowship. A number who finished last year are now assistant administrators, he says, adding that these programs help students progress more rapidly. We have a number of rural hospital administrators on our advisory board to help us think through our steps to make sure our students are prepared for those roles, Gamm says.
The university model of a core curriculum plus elective courses is an effective way to envision how training rural CEOs is different from training their urban counterparts, says Keith Mueller, director of the Rural Policy Research Institutes Center for Rural Health Policy at the University of Nebraska Medical Center, Omaha.