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by Dr. Michelle Flemmings
Published on October 17, 2018

Working in health care is hard, but working at a small hospital in a rural community is even harder. While small hospitals, especially those in rural communities, tend to face many of the same challenges larger hospitals and health systems face, we also often face challenges that are unique. 

Challenges in rural health 

Americans living in rural areas face a higher risk than urban counterparts of dying from the five leading causes of death in the United States: heart disease, cancer, lower respiratory disease, stroke and unintentional injuries. But why is this? 

Those living in rural areas face several demographic, environmental, economic and social factors that can put residents at higher risk of death. All these factors compound on each other, meaning that rural hospitals are often serve populations that are aging, shrinking, less affluent and less healthy overall. 

Geographic limitations also factor into this. About 20 percent of Americans live in what’s considered to be rural communities, but those communities cover 95 percent of our country. With limited options available in these communities, those living in rural areas tend to have to travel twice as far to the nearest hospital. This issue is aggravated by the growing number of hospitals that have been forced to close and the limited emergency services that struggle to get to some remote locations.

Resource limitations also greatly impact small, rural hospitals. Many rural hospitals operate in negative margins or are in severe debt. Further, rural hospitals often face increasing amounts of charity care and bad debt for patients that can’t afford to pay their bill before their high-premium insurance plan kicks in. And it’s not just financial resources that are limited: Rural hospitals struggle to recruit and retain top talent, especially physicians. 

Public policy tends to disproportionately affect rural health as well. Cuts to Medicare and the 340B program have contributed to the 44 percent of rural providers that are operating in negative margins. Further, Medicaid expansion has also been pointed to as having a significant impact on rural health. Studies have shown that states that have not expanded Medicaid coverage have suffered a significant increase in hospital closures as they are left with large numbers of uninsured individuals

More than 120 rural hospitals have shut their doors since 2005 due to several of these issues, and many of them have never reopened. This has left a growing number of care deserts across the country and has crippled local economies. 

So, what are the options for a small health care organization in this environment?

Being bold to overcome rural health challenges

Even with the odds seemingly stacked against us, it doesn’t mean rural health care organizations have to just accept the situation and trudge on with our heads down. It doesn’t mean we have to lower our goals and ambitions. It doesn’t mean standards and outcomes for our patients should be lesser than our colleagues in big cities across the country.

I am a firm believer that even if an organization is small, it can absolutely still be bold. Being small and being bold are not mutually exclusive characterizations.

I work at an 11-bed critical access hospital in rural southwest Colorado on the western slope of the Rockies. We’re at 7,500-foot elevation. We are four hours from the nearest level-one trauma center. We’re the very definition of “small and remote.” When a critical patient arrives at our doors, we have only one opportunity to get it right: We must promptly treat and, sometimes, facilitate the timely transfer of patients to definitive care. We must be bold to ensure we capitalize on that one opportunity to get it right.

Be bold in the technology you leverage

When it comes to technology and data, our organization has been bold. We view technology as a tremendous opportunity to provide the best possible patient care, so we invest in it. Because of this, we can make data-driven decisions and have added safety measures built into our processes and provide a better overall patient and staff experience. We were also the smallest independent critical access hospital to receive the prestigious HIMSS Stage 7 designation. 

But it’s not just us being bold at Pagosa Springs Medical Center.

Be bold in the services you offer

Carroll County Memorial Hospital (CCMH) wanted to commit to keeping their patients closer to home, so they decided to add surgery services. Not only was adding these services a success in retaining their patient population, but it also has become a revenue generator for CCMH. In the first year of offering these services, they performed more than five times the number of procedures needed to meet their goal. 

Be bold in the partnerships you build

Limited resources in rural communities isn’t just a challenge for the health care industry: It’s a common issue across most businesses in those environments. If a health care organization can form partnerships with other community organizations, together, they can help minimize this challenge. Partners are often able to share resources, combine offers and work towards the common goal of improving the community they operate in. 

Sometimes, the best partners aren’t the obvious or conventional choices. Goodall-Witcher Hospital Authority, a small hospital in rural Texas, has actually been able to form a partnership with a direct competitor. Through this partnership, both organizations have been able to reduce costs, increase specialty services and even help each other in moments of need. This type of outside-the-box thinking can be crucial for resource limited rural organizations.

Be bold in the processes you implement

Processes, particularly those that are regularly utilized in an organization, can have a significant impact, good and bad. If everyone in the organization is on the same page, it’s easier to implement processes that can make positive impacts across several areas of the business. Neosho Memorial Regional Medical Center (NMRMC) implemented LEAN thinking as a structured way to solve problems and for process improvements. This way of thinking and leading has been instrumental to NMRMC eliminating waste and increasing value to their patients. 
I am incredibly proud of the accomplishments at Pagosa Springs Medical Center, as well as the countless others I have heard of from small hospitals around the country. At the end of the day, we’re all on this journey together to help the improve the health of our communities and our country as a whole. We should always look to learn from one another, pick others up when they’re down and celebrate the successes of others as if they are our own – for all these are sources of opportunity to improve our own organizations. 

Let’s all continue to work hard, dream big and be bold.

CommunityWorksSM has brought innovative health care solutions and services beyond the highly populated metropolitan areas and into the rural and community hospital market since 2009. Learn more here.