Chinue Uecker

Leadership Insights: A QUEST to Prevent Rural Hospital Closure Dr. Chinue A. Uecker, DBA Background: In the United States, rural hospital closures increased 34% since 2015 due to financial reasons affecting access to healthcare services. For rural hospital leaders, improving the hospital’s financial performance is a valuable strategic goal. Purpose: The purpose of this qualitative multiple case study was to explore strategies rural hospital leaders implement to improve their hospital’s financial performance. Target population: The targeted population consisted of three rural hospital leaders per hospital from Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands, who have improved their hospital’s financial performance. Method: To discover what strategies rural hospital leaders used to improve hospital financial performance, the researcher interviewed rural hospital leaders until data saturation was reached and analyzed hospital documentation. Characteristics Number of study sites Geographic locations No. of study participants Key informants titles Documentation reviewed Descriptive information 6 Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, United States Virgin Islands 15 CEO, COO, CFO, CNO, Director of Finance Strategic Plans, Community Health Needs Assessments Conceptual framework: The strategic decision-making framework supported the study as top leaders make decisions that affect the organization’s health and survival. Eisenhardt and Zbaracki (1992) developed the strategic decision-making framework. Three key concepts for exploring strategic decision-making and financial performance of rural hospitals were: (a) bounded rationality, (b) politics, and (c) power. Results: Four key themes emerged from this study. Theme 1: The need for rural hospital leaders to utilize strategic decision-making when addressing rural hospital financial performance. Theme 2: Developing synergies with external providers and hospitals. Theme 3: Creating effective short-term and long-term strategies aligning to the QUEST (Quality, Utilization, Expenses/Revenue, Safety, Satisfaction, Talent, and Technology) framework. Theme 4: Translating success to the entire organization. Leadership insights: Since rural hospitals occupy a pivotal role in providing quality care and service to patients, the study results might offer strategic ideas to rural hospital leaders interested in ensuring their hospital remains open. Acknowledgements: My favorite Wilma Rudolph quote is “No matter what accomplishments you make, someone helps you.” Completion of my doctoral study would not have been possible without the support of my husband (Ben), family, friends, Walden doctoral chair and committee, study participants, and mentors. Thank you!