Recruiting Transformational Rural Healthcare Leaders
According to the American Hospital Association, 46 million people – 14% of the U.S. population – live in rural areas. Rural hospitals are facing a...
According to the American Hospital Association, 46 million people – 14% of the U.S. population – live in rural areas. Rural hospitals are facing a crucial inflection point as health systems and hospitals across the country are facing mounting pressure with declining operating margins, rising labor costs, and decreasing reimbursements. Rural hospitals are being impacted the most and have been in crisis mode long before COVID. The National Rural Health Association estimates over half of independent rural hospitals are operating in the red and are continuing to close at a rapid pace. For these rural, community-based hospitals, recruiting a CEO can be the most important decision a board makes to keep the doors open and ensurewe care is kept local.
The need for talent is at its peak, and as there aren’t a lot of these highly qualified leaders to go around, rural organizations must market themselves differently to compete for top executives’ attention. While the opportunity for a CEO to live in a small, tight-knit community is often part of the lure, these organizations can’t afford to think or show up like small-town organizations.
One hospital, a 64-bed facility in the Midwest, has continued to grow and expand to earn the coveted title of a Top 100 Rural & Community Hospital, according to the Chartis Center. Despite its size, it has turned to partnerships and innovation to stay viable and prevent more disruptive changes. Hospital leadership has focused on recruiting physicians with ties to the area and developed strong partnerships with larger systems to lean on advances in technology. They have stayed true to their mission, values, and principles while staying connected with the community, which has helped elevate their brand and lead to increased philanthropic giving. Community support and contributions have led to funding state-of-the art technologies and bringing specialized services to the community not often found in rural areas. The work continues, but by showing up and thinking big, they’ve been able to recruit many highly qualified leaders and remain independent to keep care local, their north star.
Other rural organizations must also be creative and think outside the proverbial box if they want to thrive long term in this more challenging environment, which includes the ability to attract top tier leaders they will need for the future. What follows are ideas for how smaller, often less-resourced hospitals and health systems can make themselves stand above the rest to recruit transformational executives.
Know Your Strengths and “Bigger Isn’t Always Better”
We live in a supersized world, where bigger is often seen as better. Rural hospitals are one place this isn’t the case, and these organizations can lean on that to attract transformational leaders. In a rural hospital, there are fewer layers and thus more autonomy to make decisions. A rural hospital CEO can often wear multiple hats and still play a role in operations, marketing, and philanthropy, if they choose. People like to feel acknowledged and know they are making a difference. In smaller communities, a hospital CEO is a similar position as a mayor, where the entire town knows and looks up to them. Rural healthcare environments allow a leader to be a bigger fish in a small pond, which can be attractive to some leaders.
The U.S. economy is in a strange place right now with slow job growth (in all industries), but demand (especially for healthcare) for workers is strong. Inflation remains elevated, and consumers are cutting back in many areas. With a housing market putting prices out of reach for many, cost of living is something that is high on healthcare leaders’ minds right now. A huge benefit of living in a rural area (versus urban) is a lower cost of living, along with lower stress levels. Rural areas are generally quieter, safer and less crowded, which can lead to a more relaxed lifestyle. In a world post COVID, many people, including healthcare leaders, are choosing ways to slow down their lives, and going to a rural community can be that answer.
The takeaway is that small hospitals can be very appealing to CEO candidates from across the industry. Hospital trustees and leaders must know that they can compete for talented leaders.
Think and Act Big
Even though bigger isn’t always better with respect to organizational size, rural hospitals do need to position themselves to candidates that they are future focused and thinking bigger. A transformational leader won’t be attracted to an organization that doesn’t appear to want to transform and be forward-thinking. Rural hospitals and health systems should be emphasizing quality outcomes, coordinated care, physician relationships, and integration. “What has gotten us here won’t take us forward” is ever so paramount in rural healthcare today. Many critical access hospitals I have worked with in the past may have the designation of 25 beds or less but have transformed themselves into regional referral centers. Many boast comprehensive specialty care options, a continuum of care (including senior life and post-acute care), and state-of-the-art surgical suites.
Here are a few ways that rural organizations act big:
- Embracing technology is something candidates will look for right away when viewing an opportunity. Digital health, telehealth, and AI are things driving many of the most progressive hospitals today and rural hospitals can play this game as well. Technology can be expensive, but often rural organizations can partner with larger health systems to leverage their electronic medical record and adopt more innovative ways of care.
- Strategic collaborations. There are still a good number of independent hospitals left (around 1,500 as of April 2023) but given the tenuous financial position facing rural hospitals today (and many other challenges they experience), many have chosen to explore partnerships or collaboration opportunities. These are tough decisions as hospitals may ultimately lose autonomy in such situations, but these affiliations can keep rural hospitals afloat through an infusion of resources. Leaders should seriously consider their unique market and the communities they serve, payor landscape and local competitive dynamics before pursuing partnerships.
- Legislation and policy. Rural hospitals are not reimbursed at a rate to keep up with rising costs, and by working with local legislators, rural hospitals can work to change payment policies of federal and state government programs, and in turn not only keep the doors open, but take better care of their patients by driving the quality of care.
These are a few examples of the kinds of activities that CEO candidates will notice when evaluating a job with a rural hospital.
After doing all these things to stand out and recruit top talent, rural organizations need to make sure they are choosing a leader that is the right fit for them. While every organization is different and nuanced in their needs, below are some top characteristics to look for before hiring your next CEO.
Look for Leaders Who Fit
Executives who desire to work in rural healthcare often describe it as a calling. They are sometimes the byproduct of a rural area and have the firsthand experience of the lack of access to healthcare these communities face, as well as the excellent, personal care that local facilities can provide. A desire to serve is not enough though and for executives to excel they must be able to exhibit certain skill sets, such as the following:
People-centered. To be successful in any business – especially rural healthcare – one needs to have exceptional interpersonal skills and be able to forge relationships. Hospital CEOs can no longer sit behind a desk and lead an organization. They must be visible, accessible, and able to relate to everyone from the front-line staff to the physicians to the board. It’s a critical time in healthcare where burnout has caused employee engagement to significantly drop, and a healthcare leader can play a large role in driving engagement by being present and showing they care about their employees.
Adaptable. Healthcare has always been a complex industry with a strict regulatory component, and even more so in today’s political and economic environment. Rural hospitals are at a crossroads in their ability to take care of their patients and keep the doors open with margins shrinking and costs rising. Rural hospital CEOs are confronted with daunting challenges and obstacles and need to have the foresight for future planning. Remaining independent is often the top goal, but an effective rural healthcare CEO needs to be open minded to think of partnerships and alternative models to remain viable and continue taking care of their patients.
Part of the community. In a world where remote, hybrid, and virtual are common things, rural healthcare not only prefers, but almost always requires leadership to fully relocate. Rural hospitals and health systems are often the lifeline as the largest employer in the community. Successful rural healthcare leaders become the face of the organization and ambassadors in the community. They will be expected to join civic organizations, sit on boards, and give back to the community.
Empathetic. A rural healthcare leader’s soft skills are as important (if not more) than their technical skills. They must have strong emotional intelligence and listen more than they talk. Rural healthcare is based on relationships, which in turn are built on trust and connecting with others. “Seek first to understand then to be understood” is a habit coined by Stephen Covey in The 7 Habits of High Effective People. Covey identified that to build deep relationships and lead with clarity, one must first truly understand what people are saying when in conversation. The best rural healthcare CEOs are genuinely interested in the well-being of their patients, employees, and communities.
Board-friendly. Boards can often make or break a recruitment. Talented healthcare leaders take a close look at board dynamics when interviewing. An overreaching board can be a turnoff, but a board that is enthused, engaging, and knows their position can be a powerful tool for recruiting a talented rural health executive. The buck stops at the board, and leadership will be looking at who their boss will be and if they can partner with them. Talented leaders also know the hospital’s success is strongly related to hospital board and management practices, which can be attractors to recruiting a new leader.
Have Your Cake and Eat It, Too
In the end, a rural healthcare executive can really have it all. They can lead an organization and community to improved health, while living in a beautiful and often remote part of the country. Rural leaders can often feel a bigger sense of fulfillment (than urban peers) because of a strong mission and connection to the community. The stakes are high for recruiting a truly transformative leader, but rural organizations have many things to lean on and should feel confident and competitive as they recruit their next CEO.