Rural healthcare in transition. A time for change management

The fundamental challenge for rural healthcare leaders today is to address three key questions: What is the nature of the system that is undergoing change? What are the nature and extent of the changes? What strategies are needed to manage in a climate of change? Healthcare administrators' perspective of rural healthcare systems must take into account the full range of provider organizations, promote the idea of continuum of care, and consider system and environment as mutually dependent parts of a larger whole. The environments that have influenced rural healthcare delivery and organization in the 1980s include demographics, epidemiology, economics, finances, personnel, technology, regulations, and politics. As hospital admissions and patient days declined under the pressures of cost containment, population shifts, and changes in medical practice, rural hospitals sought to maintain viability through a variety of adaptive actions, such as downsizing, forming relationships with other hospitals, and diversifying. These environmental and restructuring trends will require some degree of adaptation by rural healthcare organizations. Leaders will have to shift the organization toward a horizontal orientation, which emphasizes participation by department heads and supervisors in defining and implementing interorganizational relationships; authority for horizontal action taking and seeking out additional connections that will improve continuity and quality of care; and team-building skills to enhance cooperation and effectiveness.