As rural hospitals across the U.S. continue to grapple with financial strain, staffing shortages and service closures, healthcare leaders like Kyle Kramer, CEO of Putnam, Conn.-based Day Kimball Health, are navigating industry headwinds through strategies to help his organization adapt and thrive.
“One of the biggest challenges facing small and rural healthcare organizations is their ability to drive scale,” Mr. Kramer said during a Becker’s Healthcare Podcast episode. “As small and independent organizations, there’s limited ability to affect the reimbursement that is received from commercial payers and certainly there’s a comparable concern around supply acquisitions. Larger organizations have a better opportunity for negotiating power with payers and with suppliers of services.”
Becker’s has reported on 12 hospital and 12 maternity service closures so far in 2025, highlighting an accelerating loss of healthcare access across the United States, particularly in rural communities.
Mr. Kramer said the other piece of the puzzle is the cost of labor, particularly related to workforce, as smaller markets see smaller pools of people for employment which can come at a higher cost.
For example, if a potential hire grew up in a more rural area, they might be more likely to entertain employment in a smaller hospital market. However, for potential employees trained in or from more urban areas, they might be looking for that environment for work. Mr. Kramer said it then comes down to finding strategies to attract and retain employees.
“No. 1, being more aggressive with sign-on bonuses,” he said. “No. 2, making sure that we are offering competitive opportunities around tuition reimbursement for individuals who wish to advance their careers, loan forgiveness for individuals who are coming out of training programs, as well as offering flexible shifts or flexible schedules that attract people. So, it’s a chronic challenge. I don’t know that there’s an easy answer.”
Day Kimball Health also offers multiple programs within local high schools for certified nursing assistant certifications in an effort to introduce potential future employees to the world of healthcare.
“Through creating this type of training opportunity,” he said. “We’re giving young people exposure to the vastness of the healthcare field.”
Lastly, Mr. Kramer said leadership is key to ensuring that a hospital runs smoothly, regardless of the market size. He also relies on leadership advice that was given to him from two formative people in his life: his father and his first boss in healthcare.
Mr. Kramer’s father told him, “if you believe in yourself, you believe in your team and you put your faith in a higher power, good things will happen.”
His former boss also left him with advice that boils down to three things: oversee all, act on some and overlook a lot.
“What that has evolved to mean is that, as a leader, it’s important that you have the full and broad perspective of everything that’s going on within your organization, within the environment that you’re working with,” he said. “There’s things that you’re going to need to step into and really engage your team in advancing, and there’s some things that you’re going to have to step back from so the ability to prioritize your approach, your focus and to be able to shift sometimes on a dime, is an important part of leading through change, leading through challenge, leading through hardship, but also leading in times of winning. And I’ve carried that with me for my entire career.”
