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CHICAGO — Rural and community hospitals are the critical backbone of America’s healthcare delivery industry and they are also the most vulnerable to change — be it the regulatory landscape and reforms or the business model.

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community hospitalsThat is why the people chosen to run these critical enterprises must be exceptional. I have had the privilege of working in and for these facilities — and many others of all shapes, sizes and locales — but the rural and community hospitals have always remained close to my heart. It is here that you can make a meaningful difference for an organization, a community, and the people who depend on local healthcare providers.

I have seen some highly successful facilities and I have seen many on their last leg, the victim of a whole host of challenges — poor management, poor governance, an indifferent or underperforming medical staff, shifting market economics, a poor payer mix with declining reimbursement or, and this is the one that disturbs me the most, a lack of community will. Sometimes, market conditions — competition — require that these hospitals close. That is sad but inevitable.

In studying these facilities since the mid-1980s I have developed a list of critical factors that, assuming the hospital is in a market that requires a hospital, will produce improved results across the board if fully and deeply embraced and implemented.

  1. You do NOT need a competent Administrator or Chief Executive Office. What you do need — what you must have — is a competent leader with the experience and skills to bring together the various stakeholders to support the vision and mission of the facility. You must have a leader who respects the organization’s stakeholders and works in a way that these groups respect her or him.
  2. A board that understands governance, works to stay informed of industry changes and fully embraces the organization’s mission, vision and values in all that they say, do, and decide. One of their most important duties is to hire a leader CEO, then support the individual and hold him or her accountable for performance deliverables. The board cannot make decisions based on self interest, the interests of their friends and neighbors, or even a favored long-time physician who may not be willing to be on the team. Poor governance alone has mortally wounded more community hospitals than I can immediately recall.
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  3. The employees, including employed physicians, must be recognized as a critical asset without which the enterprise cannot function. Leadership should focus first on their needs — training, development, communication and demonstrating respect and love for who they are and what they do. If you first take good care of your employees, they will, in turn, take good care of the patients. Employees who do not feel the loving embrace and respect of leadership will not be as effective as those in competing organizations where they do. This formula is critical to quality, safety and improved patient satisfaction. You may have good months without this approach, but those results are not sustainable.
  4. Focus on the quality of the people you hire. This can be particularly challenging in some rural communities but work hard to not settle. If you face challenges in this area then you must commit to helping the employees you have to develop and meet high standards. If they are not willing to commit to meeting those standards, then find someone who will. CEOs must hold their hiring resources accountable for the quality of the people who enter the organization.
  5. Employees and physicians must return the love and respect imparted from the CEO. This sort of chemistry is powerful.
  6. The mission, vision and values of the organization should be front and center covering the actions and decisions of the employees and physicians. If you have that balance, that passion and commitment, the finances of the organization will follow.
  7. A daily culture that is propelled by a belief that good enough is never good enough. Excellence every day, in every action, must be the gold standard. From this will come quality and safe care and improved patient satisfaction. A second cultural pillar must be — not should be or hoped for — trust at all levels.
  8. Destroy anything that looks like a command-and-control management model! Replace it with leadership that empowers employees to look for ways for performance improvement. Some of the most amazing solutions to problems I have seen in rural and community hospitals were bottom up, not top down.

We all must remember, from the board and CEO to the nurses, dietitians and housekeepers — and most certainly executive recruiters who work in this space — that to work in a hospital is a privilege, not a right.

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Editor’s Note: From 1980 to 1987, Mr. Self served as a senior executive for Hermann Affiliated Hospital Systems, a network of 25 managed and 23 affiliated rural and community hospitals that he helped develop. He also served as an interim CEO for network members.