“A rural hospital encapsulates all the major services a major service hospital does, but sometimes it has less employees per hospital that one department in a major hospital,” said Kelly Arduino.
Ms. Arduino, a partner in Wipfli’s healthcare practice, shared her knowledge about rural hospitals and their unique business models at the Becker’s Hospital Review 6th Annual Meeting in Chicago. Here are five insights she shared about the unique cultures of rural hospitals, the challenges they face in representation and the relationship they share with the community.
1. For these organizations, geography can dictate culture. In rural areas, geography is inexplicably linked to hospital culture. It determines where people go for care and how hospital employees understand their patient base. “If there is a river or a mountain in the area, you either go here or you go there,” she said. There are the valley people and the mountain people.”
2. People are fiercely loyal to their hospital. One positive trait that can prove difficult at times is the amount of loyalty residents feel toward their local hospital, especially since these are employment hubs in the community. To survive, many longstanding independent hospitals are forced to partner or affiliate with a larger organization, but the community is still accustomed to a full-service hospital running on its own. Partnerships are not always seen as a positive thing. “Healthcare, not a hospital, is what the community needs,” said Ms. Arduino. “That will be somewhat of a cultural shift.”
3. Community hospital leaders are scrappy. In rural hospitals, executives wear many hats, and their ability to perform different roles is a huge advantage to their organizations. The COO may also serve as CIO and quality manager. The CEO may moonlight as the chief human relations officer and physician recruiter. “I’ve yet to meet a C-suite that didn’t have at least three jobs for one person,” said Ms. Arduino. “This is a scrappy group.”
4. Bigger isn’t always better. “There’s this notion in rural that if we joint his system, all of our problems will be solved. I say don’t do that. Don’t assume that,” said Ms. Arduino. Many health systems have several acute-care hospitals and fewer critical access hospitals, which can create an uneven playing field for strategic discussions and resources. Ms. Arduino’s organization organizes advisory groups of rural hospitals to discuss issues and bring their problems to a larger system as a whole. One advisory group in Minnesota includes five rural hospitals. Leaders meet regularly to discuss challenges and then bring those issues to the larger system board together.
5. Seven key statistics
The typical rural hospital:
· has 25 beds;
· employs 321 FTEs;
· is located in a county with a median population of 27,980;
· has a total margin of approximately 2.7 percent;
· has 58 days cash on hand (but many operate with 10-15 and they always will due to challenges of their market, said Ms. Arduino);
· has a patient base where 31 percent are Medicare patients and 16.8 percent of the population is over the age of 65;
· and has a patient base where 17.5 percent live below the federal poverty level.
