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Rural Health Information Hub

Supporting Rural Health Leadership and Management

In rural areas, the vitality of healthcare facilities and organizations often relies on the presence of capable leaders who can navigate the unique opportunities and challenges of serving rural communities. Effective management and leadership skills are critical for sustaining success in delivering essential healthcare services. The distinction between management and leadership is important, but more often than not, individuals must fulfill both roles simultaneously in rural organizations. Management focuses on operational efficiency, resource allocation, technical considerations, and day-to-day responsibilities to achieve goals and objectives. Skilled management, specific to the context of a rural community, is critical to continued financial success and growth.

Leadership encompasses a broader vision, setting the mission and strategic plan for the organization, stronger emphasis on interpersonal effectiveness, and inspiring and guiding teams and individuals to meet goals. Leaders with vision can help rural communities achieve higher levels of health through effective programming, development of infrastructure, leveraging of community and regional resources, and acquisition of external funding/support.

This guide will help rural communities find resources and strategies to ensure they have the leaders and managers needed now and in the future to meet residents' health and healthcare needs.

Frequently Asked Questions

Leadership and Management

Governance

Collaboration

Management and Leadership Workforce

Strategic Planning

Ethics

Leadership and Management

What are the similarities and differences between leadership and management?

Leaders set the vision, mission, and strategic plan for an organization, while managers ensure that day-to-day activities of the organization are carried out to meet the organizational objectives and goals. Oftentimes individuals in rural healthcare settings find themselves fulfilling both roles simultaneously. In a June 2024 interview in the Rural Monitor, UCHealth Yampa Valley Medical Center President Soniya Fidler shares her experience growing into a leadership role and the skills needed to make the transition from management to leadership.

What are the main functions of management and ways that individuals can lead in a rural healthcare setting?

Managers must ensure that the overall goals and objectives of the organization are accomplished. They must be capable of planning, organizing, staffing, directing, and monitoring the work of their units. They must also be skilled at facilitating knowledge, motivate workers, and be adept decision-makers to accomplish set goals and objectives. For an overview of management tasks and skills, see The Community Toolbox, Chapter 15: Becoming an Effective Manager, from the University of Kansas Center for Community Health and Development.

When in leadership positions, managers experience a shift towards more interpersonal and less technical work, with an emphasis on leading change and influencing people. Additionally, leaders must also be able to work with individuals and organizations external to their organization to convey information, collaborate to achieve organizational goals, and communicate the organizational vision. For a broad overview of leadership, see The Community Toolbox, Chapter 14: Core Functions in Leadership.

What are the core set of leadership skills essential for rural healthcare leaders to be successful?

Some of the key skills that a rural healthcare leader needs include:

  • The ability to navigate the resources that are already available.
  • An openness to explore ideas, research opportunities and solutions, and willingness to make innovative change.
  • A good understanding of the community, affiliate organizations, competitors, and the regional healthcare environment. The ability to look beyond their own four walls rather than narrowly focus on just their own organization.
  • Awareness of their role in the community, often as the largest employer.
  • Knowledge and expertise across multiple facets of the healthcare industry. Rural leaders wear many hats and must deal with everything from accreditation to compliance to finance and more.
  • Motivation and the ability to motivate a broader team.
  • Grit and resilience.
  • Willingness to make decisions that aren't popular but ultimately advance the health of their community and are consistent with the organization's mission.
  • The ability and patience to build a team and empower them to be leaders themselves.
  • Adeptness at communication, both internally and externally.

What resources are available for rural health leadership development opportunities?

A 2020 Rural Health Value publication, Assessing Your Leadership Competencies, identifies several leadership assessment tools that can help determine areas for professional development.

The National Rural Health Resource Center offers a Leadership Development collection of videos and podcasts for rural health senior leaders and hospital boards. Depending on an organization's circumstances, its leader may need a wide range of tools to prepare for and deal with needed cultural and practical change. For example, Rural Health Value's Management Methodologies and Value-Based Strategies: An Overview for Rural Health Care Leaders provides methods and strategies leaders can use to transition rural healthcare organizations to value-based care.

The National Rural Health Association's Rural Health Fellows Leadership Program offers a structured, year-long experience to learn, contribute, and develop connections with other rural health leaders. NRHA and the Center for Rural Health Leadership offer a variety of certification programs for rural hospital leadership roles. NRHA also offers many opportunities to contribute to rural health via constituency groups and national conferences. Many states also have active state rural health associations which offer learning and networking opportunities. For more examples of leadership development opportunities, see the 2023 Rural Monitor feature Changing the Narrative – Rural Healthcare Opportunities and the Role of Emerging Leaders.

Rural health leaders can also stay current on issues through podcasts such as Harvard Business Review (HBR) on Leadership and Exploring Rural Health. In addition, Rural Health Leadership Radio, a podcast that ended in July 2024, has an archive of over 400 episodes of interviews with rural health leaders.

Rural health leaders may also seek to learn on a wide range of issues that may impact their facilities. A variety of topic guides are available on RHIhub, including a guide on Rural Health Policy and guides focused on specific facility types and healthcare services.

How can current or future rural health leaders learn about their leadership style?

Leaders may find that understanding the different approaches to leadership that are possible, as well as their own natural tendencies as a leader, can help them grow and better meet the needs of their organization. Styles of Leadership, in Chapter 13 of The Community Toolbox, identifies different leadership styles and how they impact an organization, as well as insights about how to choose and grow into an appropriate leadership style.

The National Rural Health Resource Center offers a Collaborative Leadership Self-Assessment that can help identify behaviors to develop as a rural health leader. Leaders may also want to better understand their values through the Center for Ethical Leadership's Self-Guide Core Values Assessment.

Governance

What is healthcare governance?

The governance of healthcare organizations in a rural setting involves the structures, processes, and mechanisms by which healthcare services are organized, managed, and overseen to ensure the delivery of high-quality care to rural populations.

At its core, healthcare governance embodies the framework through which these organizations are directed, monitored, and held accountable. It's not just about bureaucratic processes; it's about ensuring that every decision made aligns with the organization's mission of providing quality care to its community. Picture a rural health board meeting, where dedicated individuals gather to steer the course of their local healthcare institution. The board's effectiveness is paramount, serving as the linchpin between the community's needs and the organization's actions.

Helping Boards Help Rural Hospitals, a 2024 episode of the American Hospital Association (AHA) Advancing Health podcast, features Barbara Sowada, president of the Board of Trustees at Memorial Hospital, discussing how hospital boards can help rural healthcare facilities address financial and workforce concerns.

What are the different board structures and what impact does a board’s structure have on a healthcare organization?

Within the realm of governance, structure matters. Different board configurations wield distinct impacts on healthcare organizations. In rural settings, where resources may be scarce and populations dispersed, these considerations take on added significance. Discussions around governing versus advisory boards, system versus subsidiary boards, and for-profit versus nonprofit distinctions are not merely theoretical; they shape the very fabric of healthcare delivery in these communities. Further, when a board structure needs to change, for example when a rural hospital affiliates with a larger system and becomes a subsidiary board, a focus on leading through the change and keeping board members fulfilled in their volunteer work is critical.

For information about the different healthcare board structures, see a 2023 interview with Jamie Orlikoff in the American Hospital Association (AHA) Trustee Insights, A Taxonomy of Health Care Boards. The AHA Trustee Services website provides additional resources focused on hospital and health system board development.

What are unique considerations for rural health governance?

Rural health governance faces distinct challenges due to factors like limited resources, geographical isolation, and unique healthcare needs. Boards must navigate these complexities while ensuring equitable access to quality care. They may need to develop innovative solutions to address transportation barriers, workforce shortages, and the integration of telemedicine. Additionally, fostering strong partnerships with community members and leveraging local resources are crucial for sustainability.

What are the similarities and differences between a governing board and an advisory board?

Governing boards hold legal authority and accountability for the organization's strategic direction and overall performance. They make key decisions, set policies, and oversee management. In contrast, advisory boards offer guidance and expertise but lack decision-making authority. While both play important roles, governing boards have ultimate responsibility for the organization's success, while advisory boards provide valuable input and support.

Advisory boards and governing boards serve distinct roles within organizations, but they also share some similarities. Both advisory boards and governing boards facilitate engagement by representing the interests of various groups, including employees, customers, investors, community members, and other relevant parties. They serve as conduits for gathering feedback, addressing concerns, and promoting transparency and accountability. Both types of boards support organizational leadership by offering insights, advice, and mentorship to executives and management teams. They serve as sounding boards for ideas, provide access to networks and resources, and help leaders navigate complex challenges and opportunities.

Here are several ways that governing boards and advisory boards differ:

Difference Between Governing Boards and Advisory Boards
Difference Type Governing Board Advisory Board
Decision-Making Authority Holds ultimate decision-making authority and is responsible for setting the organization's strategic direction, approving budgets, hiring executives, and overseeing major policies and initiatives. Provides recommendations and guidance to the governing board and executive leadership but does not have formal decision-making authority. Its role is advisory rather than authoritative.
Legal Responsibility Bears legal responsibility for the organization's actions and performance, including fiduciary duties such as ensuring financial solvency, compliance with regulations, and adherence to ethical standards. Typically, does not have legal responsibility for the organization's actions and is not held accountable for its performance. Its role is to offer advice and expertise without assuming legal liability.
Composition and Expertise Comprises individuals with diverse backgrounds, expertise, and experience relevant to the organization's mission and operations. Members may include executives, industry professionals, and community leaders. Consists of experts and interested parties from various fields who offer specialized knowledge, skills, and perspectives to support the organization's goals and initiatives. Members are selected for their expertise rather than their fiduciary responsibilities.
Strategic Guidance Make final decisions about the organization's strategic direction. Make recommendations and offer input to inform the strategic direction of the organization.

What are the similarities and differences between a system board and a subsidiary board?

System boards oversee multiple entities within a healthcare system, ensuring alignment of goals and strategies across the network. They set overarching policies and provide oversight but may delegate operational decisions to subsidiary boards, which govern individual entities like hospitals or clinics. Subsidiary boards focus on the specific needs and priorities of their respective organizations while adhering to the broader vision set by the system board. How to Navigate Complex, Multitiered Governance, from AHA Trustee Services, provides an overview of how leadership, the subsidiary board, and the system board work together. This section also offers a Sample Governance Authority Matrix that can be used to clarify what authority resides with the subsidiary board versus the system board.

The differences between a rural hospital system board and a rural hospital subsidiary board can vary based on organizational structure and governance practices, but here are four major distinctions commonly observed:

Difference Between Hospital System Board and Hospital Subsidiary Board
Difference Type Hospital System Board Rural Hospital Subsidiary Board
Scope and Responsibility Oversees the entire hospital system, which may include multiple facilities, clinics, and ancillary services. Its responsibilities typically include strategic planning, financial oversight, and setting policies and goals for the entire system. Focuses on the operations and governance of a specific hospital within the system. Its responsibilities may include ensuring quality of care, compliance with regulations, and addressing the unique needs and challenges of the individual hospital.
Decision-making Authority Holds ultimate decision-making authority for the entire system, including resource allocation, major capital investments, and system-wide policy decisions. Makes decisions specific to the hospital it governs, such as hiring key personnel, approving budgets, and implementing policies tailored to the hospital's needs, within the framework set by the system board.
Composition and Expertise Typically comprises members with diverse backgrounds, including healthcare professionals, community leaders, finance experts, and representatives from affiliated organizations. This diversity ensures a broad perspective on system-wide issues. May consist of members who have specific expertise relevant to the operations and challenges of the hospital, such as local healthcare professionals, community members, and individuals with experience in healthcare administration.
Integration and Communication data-title="Hospital System Board" Coordinates and integrates the activities and resources of multiple facilities within the system, fostering collaboration and synergy among them. Communication channels often span across various levels of the organization to ensure alignment with system-wide goals. Focuses on fostering effective communication and collaboration within the specific hospital it governs, ensuring that local needs and concerns are addressed while aligning with the broader goals and strategies set by the system board.

These differences highlight the distinct roles and responsibilities of each board within the context of a rural healthcare system, aiming to optimize governance and decision-making at both the system-wide and local levels.

What are the similarities between nonprofit and for-profit boards?

Nonprofit and for-profit boards share core responsibilities such as setting strategic direction, ensuring financial sustainability, and overseeing organizational performance. Both must act in the best interests of their constituent groups. However, nonprofit boards have different constituent and regulatory requirements. The community members are the constituents of a nonprofit, whereas in a for-profit organization, you may have private shareholders. Health Center Board Roles and Responsibilities from the National Association of Community Health Centers is one example of nonprofit board expectations. See Nonprofit vs. Not-for-Profit vs. For-Profit: What's the Difference? from the U.S. Chamber of Commerce for tax, governance, and other requirements.

Nonprofit and for-profit boards share several similarities despite some of their differences. Here are some commonalities between the two:

  • Fiduciary Responsibility – Both nonprofit and for-profit boards have a fiduciary responsibility to act in the best interests of the organization. This includes overseeing financial management, ensuring compliance with legal and regulatory requirements, and safeguarding the organization's assets.
  • Strategic Oversight – Boards in both sectors are responsible for providing strategic oversight and direction to the organization. They set long-term goals, review and approve strategic plans, and monitor performance against established objectives to ensure the organization's mission and vision are achieved.
  • Executive Leadership Oversight – Boards hire, evaluate, and, if necessary, replace executive leadership, such as the CEO or executive director, in both nonprofit and for-profit organizations. They are responsible for ensuring that the organization has effective leadership in place to execute its mission and achieve its goals.
  • Constituent Representation – Boards represent the interests of various constituents, including shareholders (in for-profit organizations) or donors, beneficiaries, and the community (in nonprofit organizations). They serve as a link between the organization and its constituent groups, advocating for their interests and ensuring their voices are heard in decision-making processes.
  • Governance Structure – Nonprofit and for-profit boards typically have a similar governance structure, with a board of directors or trustees responsible for overall governance and oversight of the organization. They may establish committees to focus on specific areas such as finance, audit, governance, or strategic planning.
  • Commitment to Mission and Values – While the specific mission and values may differ between non-profit and for-profit organizations, both types of boards are committed to upholding and advancing the mission and values of the organization. They ensure that organizational decisions and actions align with the organization's purpose and contribute to its overall impact and success.
  • Accountability and Transparency – Boards in both sectors are accountable to interested parties for their actions and decisions. They operate with transparency, providing access to relevant information about the organization's operations, finances, and performance, and ensuring that they act ethically and in accordance with applicable laws and regulations.

While nonprofit and for-profit boards may have distinct constituent groups, goals, structures, and operating environments, these shared similarities underscore the fundamental principles of effective governance and oversight that apply across sectors.

What are the different processes for selecting board members?

Rural hospitals may employ various processes for selecting board members, depending on their organizational structure, governance model, and legal requirements. AHA Trustee Services offers Sample Guidelines for Director Selection, which lists factors such as skills, experience, and personal qualities that might be considered in the board member selection process.

Here are some common processes for selecting board members for rural hospitals:

  • Election by Community Members – In this process, community members within the hospital's service area can vote for candidates running for seats on the board. Candidates may be nominated through a formal nomination process, and elections are typically held at regular intervals, such as annually or biennially.
    Impact: Election by community members ensures that board members are accountable to the local community and reflects community preferences and priorities. It promotes democratic participation and community engagement in hospital governance.
  • Appointment by Nominating Committee – A nominating committee, composed of current board members or other interested parties, is responsible for identifying and vetting potential candidates for board positions. The committee may solicit nominations from the community, review candidate qualifications, and recommend individuals for appointment to the board.
    Impact: Appointment by a nominating committee allows for a more structured and deliberate process of selecting board members. It ensures that candidates possess the necessary skills, expertise, and qualities to effectively serve on the board, enhancing board effectiveness and governance quality.
  • Appointment by Board Leadership – In some cases, board members or board leadership may have the authority to appoint new members to fill vacancies or expand the board. This process may involve informal discussions, recommendations from existing board members, or direct invitations to individuals with specific expertise or connections to the community.
    Impact: Appointment by board leadership can expedite the selection process and ensure continuity in board membership. However, it may also raise concerns about transparency, accountability, and potential conflicts of interest if appointments are made without sufficient input or oversight.

Regardless of the selection process used, rural hospitals often seek input and engagement from the local community in identifying potential board members. This may involve outreach efforts, public announcements, community forums, or surveys to solicit feedback on desired qualities and characteristics of board candidates. Community input and engagement help ensure that board members represent the interests, values, and priorities of the rural community. It fosters trust, transparency, and accountability in hospital governance, strengthening the hospital's connection to the community it serves.

The selection process for board members should align with the hospital's governance structure, legal requirements, and organizational culture. By implementing a transparent, inclusive, and merit-based selection process, rural hospitals can enhance board effectiveness, community engagement, and organizational performance.

What is the difference between governance and management?

Rural healthcare facility governing boards often face challenges distinguishing between the roles of governance and management. The board serves 4 primary roles:

  • Hiring the CEO
  • Planning for the future
  • Oversight for quality and patient safety
  • Approving the budget 

The difference between governance and management lies in their focus, scope of authority, and level of involvement in decision-making within an organization.

Difference Between Governance and Management
Difference Type Governance Management
Focus Governance primarily concerns itself with the strategic direction, oversight, and accountability of an organization. It ensures that the organization's mission and objectives are aligned with interested parties' interests. Management is concerned with the implementation of the organization's strategies and policies to achieve its goals. It focuses on executing plans, allocating resources, and overseeing daily operations.
Scope of Authority Governance sets the overarching policies, objectives, and values that guide the organization's operations. It establishes the framework within which management operates. Management has authority over specific departments or functions within the organization. It is responsible for making operational decisions, managing resources, and ensuring the organization's efficient functioning.
Level of Involvement Governance typically involves high-level decision-makers such as a board of directors or trustees. These individuals are responsible for representing the interests of interested parties, setting goals, and monitoring organizational performance. Governance is less involved in day-to-day operations. Management is actively involved in the day-to-day operations of the organization. It includes roles such as executives, department heads, and supervisors responsible for coordinating activities, managing staff, and achieving performance targets.

In essence, governance sets the direction and provides oversight to ensure that the organization operates in line with its mission and values, while management is responsible for executing plans, making operational decisions, and ensuring the efficient functioning of the organization on a day-to-day basis.

What resources are available to help build a competent board?

A June 2010 report from the South Carolina Rural Health Research Center, Is Your Hospital's Board Prepared to Govern? Rural Acute Care Hospital Boards of Directors: Education and Development Needed, includes a section on rural board skills and knowledge, as well as perceived training needs on topics such as legislative concerns, strategic planning, and more.

There are many training options available to prepare board members.

The AHA Trustee Services offers a Trustee Toolkit that collects resources focused on board and governance practices, as well as a Board Leader Resources document that lists tools and publications addressing leadership development, board chair-CEO relationships, committees, and more.

For information targeted to rural boards, NRHA's Rural Health Board of Trustees Certification Program is a fee-based course for rural hospital board members available via the Center for Rural Health Leadership.

Guidance is also available for boards on specific concerns. For example, the National Rural Health Resource Center's Visionary Board Leadership and the Transition to Value Video Series provides an introduction on the transition to value and population health.

There are also occasional opportunities for board training for specific facility types, for example the National Association of Community Health Centers New Board Chair Leadership Program.

More general resources for board training are also available. The online nonprofit magazine Blue Avocado offers a collection of Board Management articles. The nonprofit BoardSource's Recommended Board Practices identifies a wide range of board activities and how they should be conducted, covering topics related to finance, meetings, committees, and more.

How can rural healthcare leaders ensure that their boards reflect the community?

The AHA Institute for Diversity and Health Equity identifies pathways to develop a representative board in Diverse Representation in Leadership and Governance, listing steps and examples along a continuum from exploring to transforming the organization. AHA Trustee Services provides a range of additional guidance in Creating a More Diverse and Inclusive Board, Competency-Based Succession Planning, and the sample Policy on Board Composition.

Some facilities, for example Federally Qualified Health Centers, must have a board that includes patients and community representatives, as explained in the Health Center Program Compliance Manual, Chapter 20: Board Composition.

Rural healthcare leaders can take several steps to ensure that their boards reflect the community they serve:

  • Community Needs Assessment – Conduct a thorough assessment of the community's demographics, health needs, cultural diversity, and socioeconomic characteristics. Understanding the community's profile will help identify gaps in representation and inform board recruitment efforts.
  • Engage Interested Parties – Actively engage with community members, including patients, caregivers, community leaders, local businesses, faith-based organizations, and advocacy groups. Seek their input on board composition and priorities and involve them in the board selection process to ensure diverse representation.
  • Recruit Diverse Candidates – Implement inclusive recruitment strategies to attract candidates from diverse backgrounds, including racial and ethnic minorities, women, LGBTQI+ individuals, people with disabilities, and representatives from underserved populations. Often in a rural environment, identifying potential board members can be done by focusing on the largest employer, the local school system, the faith-based community, and the farming community. Use targeted outreach, networking, and partnerships with community organizations to identify potential board members.
  • Promote Transparency – Maintain transparency in the board selection process and make information about board vacancies, qualifications, and responsibilities readily accessible to the community. Provide opportunities for interested individuals to learn about the board and express their interest in serving.
  • Board Training and Development – Offer training and development opportunities for current and prospective board members to enhance their understanding of rural healthcare issues, governance best practices, ethical standards, and cultural competence. Provide resources and support to help board members effectively represent the community's interests and contribute to board effectiveness.
  • Create Advisory Committees – Establish advisory committees or task forces composed of community members to provide input on specific healthcare initiatives, programs, or policies. These committees can serve as forums for community engagement and collaboration, allowing diverse voices to be heard on important healthcare issues.
  • Rotate Board Membership – Implement policies for rotating board membership to ensure turnover and bring in fresh perspectives. Encourage term limits and staggered terms to prevent board stagnation and promote inclusivity by providing opportunities for new voices to participate in governance.
  • Foster a Culture of Inclusion – Create a board culture that is welcoming and respectful to all. Foster open dialogue, respect differing viewpoints, and actively seek input from all board members. Ensure that board meetings and decision-making processes are inclusive and welcoming to diverse perspectives.

By taking these proactive measures, rural healthcare leaders can ensure that their boards are reflective of the community they serve, thereby enhancing accountability, representation, and responsiveness to community needs in healthcare governance.

Collaboration

What role does the community have in rural healthcare leadership?

The connections between leaders in rural communities — healthcare, business, and others — are vital supports for leaders themselves and contribute to the overall effectiveness of each organization. The relationship that the community has with the leader and the value placed in that relationship can determine the overall community trust in the healthcare organization. Listening sessions with community members are one method for ensuring that the needs of the community are understood.

Rural Health Value offers the Rural Community Engagement Resource Guide, which describes the role of community engagement in developing health strategies and identifies tools for rural facilities. The National Rural Health Resource Center describes a Community Care Coordination approach to engage rural residents in addressing health concerns.

For a broad overview about how the community and the healthcare sector work together, see the Community Vitality and Rural Healthcare topic guide.

Why is it important for leaders to be involved in their communities? How can leaders develop collaborative and cross-sector partnerships in their communities?

All healthcare leaders need a commitment to the communities they are serving. In rural spaces, there are fewer leaders to share this responsibility, so it is critical for administrators to be involved in activities and organizations across the community. For example, participating in community events, the school system, and other opportunities will help the rural leader better understand the needs of the community while also helping support its social and economic infrastructure.

Building relationships with community partners can help rural healthcare leaders better understand the communities they serve. Some ways to develop these partnerships:

  • Get involved. Go to meetings of service organizations such as Rotary, Chamber of Commerce events, and similar opportunities.
  • Have lunch on a regular basis with other community leaders.
  • Host events at the hospital or healthcare facility and invite community partners.
  • Form or join a rural health network or other collaborative venture, such as a coordinating council or inter-agency council.

The Community Toolbox: Chapter 13, Section 11: Collaborative Leadership provides an overview of the leadership skills needed and circumstances where a collaborative approach will be most effective.

Collaboration with other healthcare providers can result in cooperation to better meet residents' needs. A Guide for Rural Health Care Collaboration and Coordination, a Health Resources and Services Administration (HRSA) publication, offers a template and discussion questions for developing partnerships among hospitals, health centers, and public health departments, so they can work together to address their community's health needs. The 2024 Flex Monitoring Team report Critical Access Hospital-Local Health Department Partnerships to Address Rural Community Needs explores rural health collaborative partnerships and activities these partnerships undertake.

Working with organizations outside of healthcare can open up new opportunities to achieve goals that impact health. For rural examples of this, the Association of State and Territorial Health Officials (ASTHO) shares information on the Health in All Policies approach in Supporting Resilience in Rural Areas Through Cross-Sector Partnerships. For more details on how public health agencies can engage in these types of partnerships, see ASTHO's Initiating Cross-Sector Partnerships to Advance Population Health.

The Rural Health Equity Toolkit's Fostering Multi-Sector Collaboration to Advance Health Equity offers examples of potential partners for healthcare facilities, considerations in creating these types of collaborations, and examples from rural communities. The Build Healthy Places Network offers an overview of how these cross-sector partnerships can support health in A Primer for Multi-Sector Health Partnerships in Rural Areas and Small Cities and detailed action steps in A Playbook for New Rural Healthcare Partnership Models of Investment.

What is a neutral convener and how might that be of benefit to rural community partnerships?

It is easy in areas with limited resources to develop turf issues, with a leader or organization feeling a particular issue or topic is their territory and others should not address it. A neutral convener — such as a State Office of Rural Health or grant technical assistance provider — can help to ensure all voices on an issue are heard and that data is used to drive decision-making. Neutral conveners can also help level the playing field between large organizations such as hospitals and other smaller offices, clinics, and nonprofits in a community.

The AHA Institute for Diversity and Health Equity, in Community Partnerships: Strategies to Accelerate Health Equity, states that:

“Partnerships involving multiple stakeholders, or addressing particularly contentious or complex topics, benefit greatly from having a neutral convener or facilitator. This local person or group/team can play the crucial role of ‘interpreter’ among different sectors. These sectors may use the same words or definitions but interpret their meanings differently, so having someone clarifying the dialogue can be particularly helpful during a partnership's initial operations.”

How can leaders ensure sustainability in rural healthcare collaboration efforts?

Some approaches to support ongoing collaboration include:

  • Making the time and effort to work on sustainable solutions for all involved from community partners to patients.
  • Setting up regular meetings that are announced ahead of time at a set date and time.
  • Having multiple times available for community members to engage.
  • Creation of committees with goals of what outcomes you are looking for.

What role do tertiary health systems have in rural healthcare leadership?

Increasingly leaders of tertiary healthcare systems have more of a role to play in ensuring that rural health leadership is in place and sustained. This includes supporting the selection of local board members, staffing and/or hiring leaders for local positions, and developing relationships with existing leadership. Knowing when to affiliate depends on many factors — financial, operational, and so on. Tertiary healthcare systems acting in good faith can be helpful to rural facilities in making these decisions. The Commonwealth Fund, in the 2023 publication How Regional Partnerships Bolster Rural Hospitals, features six partnerships and identifies themes and lessons from them.

Management and Leadership Workforce

What are the unique challenges of recruitment and retention of managers and leaders in rural healthcare?

Rural facilities may find that, similar to other positions, hiring healthcare executives can be difficult. There is less access to qualified candidates, for example, and fewer resources to train current staff members to assume higher level positions. For a broad overview, see the Recruitment and Retention for Rural Health Facilities topic guide.

What role do leaders play in recruiting, developing, and retaining management talent?

Leaders play an important role in the development of staff. They are the key to ensuring that staff in management roles have a healthy work-life balance which can result in improved patient outcomes.

3RNET's 2023 Recruiting for Retention Academy Summary identifies approaches that leaders can consider for hiring staff that are a good match for their particular organization.

The Community Toolbox, Chapter 13, Section 1: Developing a Plan for Building Leadership explains how to set goals for leadership development and describes a variety of methods such as mentoring, retreats, and leadership exchange programs that can be used to help staff develop leadership skills. In the same chapter, Section 7: Encouraging Leadership Development Across the Life Span, opportunities to encourage leadership from childhood through retirement can be particularly useful in rural areas where developing local talent and continuing to benefit from it can help address recruitment challenges.

What resources are there for managers and leaders looking for jobs in rural healthcare?

3RNET lists rural healthcare administration jobs nationwide. Job seekers must register to see full job listings, but there is no charge.

How can leaders promote employee professional development in rural healthcare settings?

Setting aside budget funds for continued development is key to ensuring that employees are successful. Leaders may also want to offer paid time off for classes, encourage staff to attend online events and in-person conferences, and otherwise support networking and learning. For more information on continuing education, see the Education and Training of the Rural Healthcare Workforce topic guide.

What strategies can leaders use to address burnout among rural healthcare professionals?

Prevention strategies are key to combatting burnout. For example, building in time for appropriate work-life balance can help prevent burnout. Retaining Rural Health Care Professionals: Strategies to Reduce Burnout, a 2023 National Rural Health Association policy paper, offers policy recommendations that employers can use to help support and retain staff. Strategies and Interventions to Improve Healthcare Professionals' Well-Being and Reduce Burnout, a letter in the Journal of Primary Care & Community Health, recommends using multiple approaches to address burnout, including:

  • Adequate staffing to allow for manageable work hours and realistic workloads
  • Stress management through activities like meditation and counseling
  • Professional development opportunities
  • Supportive, approachable managers
  • Peer support and connection, through activities such as book clubs and mentoring
  • A work culture that encourages balance, with regular breaks for rest and meals, paid time off, and flexible work schedules

How can rural healthcare organizations ensure diversity in their future leadership teams?

Building diversity is an ongoing process. There are many types of diversity that are needed in leadership teams. Leaders from diverse backgrounds, gender diversity, and diversity as related to race/ethnicity are all important. The Rural Health Equity Toolkit's Committing to Building and Retaining a Diverse and Inclusive Workforce to Improve Health Equity identifies strategies to support a diverse workforce, as well as examples from rural communities.

Strategic Planning

What are key considerations for the future of rural healthcare that leaders need to be aware of to ensure organizational sustainability and financial success?

Key considerations for leaders include sustainability, financial success, and, above all, the ability to meet the healthcare needs of rural populations. Leaders must anticipate and address challenges such as changing reimbursement models, workforce shortages, technological advancements, and shifting demographics. Embracing telehealth and other innovative care delivery models can improve access and efficiency. Pressing issues for health leaders to stay apprised of include the growth of AI, cybersecurity threats and disaster preparedness more broadly, and workplace violence. Collaborating with community partners, advocating for policy changes, and investing in workforce development are essential for ensuring organizational sustainability and financial success in the evolving landscape of rural healthcare.

Several topic guides and toolkits are available for exploring these topics:

Ethics

What are the ethical considerations for leading a rural health organization?

When leading a rural health organization, several ethical considerations take precedence due to the unique challenges and dynamics of rural healthcare settings. The Dartmouth Medical School Department of Community and Family Medicine's Handbook for Rural Health Care Ethics, published in 2009, provides a detailed review of ethical concerns in rural health settings, along with case studies and resources. Some key concerns include:

  • Equitable Access to Care – Ensuring that all members of the rural community have fair and timely access to healthcare services is paramount. Ethical leaders must address barriers such as geographic remoteness, transportation challenges, and financial constraints to ensure that no one is left behind in accessing essential medical care.
  • Quality of Care – Maintaining high standards of care despite resource constraints is a crucial ethical consideration. Leaders must prioritize patient safety, effective treatment, and evidence-based practices while navigating limitations in staffing, technology, and infrastructure commonly found in rural areas.
  • Provider Recruitment and Retention – Ethical leadership involves addressing the persistent challenge of recruiting and retaining healthcare providers in rural settings. Leaders must prioritize efforts to attract and support healthcare professionals, offering competitive salaries, professional development opportunities, and a supportive work environment to ensure continuity of care for rural populations.
  • Community Engagement and Cultural Competence – Engaging with the local community and respecting its cultural values and preferences are essential ethical imperatives. Leaders must actively involve community members in decision-making processes, seek input on healthcare priorities, and ensure that services are culturally appropriate and sensitive to the needs of diverse rural populations.

A December 2024 Exploring Rural Health podcast episode, Ethical Aspects of Rural Healthcare, with Stephanie Larson and Devora Shapiro, provides additional examples of ethical concerns for rural providers.

By prioritizing these ethical considerations, leaders in rural health organizations can work towards fostering trust, equity, and quality in healthcare delivery, ultimately improving the health outcomes and well-being of rural communities.

Last Updated: 12/9/2024
Last Reviewed: 12/9/2024