Healthcare Leadership Perspectives on Priority-Setting, Geriatrics and Rural Care, and Effective Advocacy Strategies:...

In allocating resources, healthcare system leaders must balance multiple competing priorities. To gain insight into how geriatrics champions can effectively "move the needle" in advocating for geriatrics services, we asked healthcare system leaders about their process of priority-setting, their views on geriatrics in general and services for rural older adults in particular, and about recommended communication strategies for geriatrics champions.

We conducted interviews with 11 former leaders in the Veterans Health Administration (VHA), who represented all four major census regions in the United States and had over 250 years of VHA leadership experience combined. The first three interviews were exploratory, and the subsequent eight interviews were semi-structured. All 11 interviews were analyzed through team-based rapid qualitative analysis.

Participants described a range of factors affecting healthcare system leaders' decision-making, including balancing ongoing needs (e.g., meeting patient needs, managing budgets), emergent issues that could force their way to the top (e.g., "crises du jour"), and personal factors. On any given day, pressing priorities could eclipse geriatrics services, including those delivered in rural areas. Participants felt that geriatrics services were valuable but not highly visible, that realities of rural communities presented unique challenges, and that workforce gaps were problematic for both geriatrics and rural care. Participants shared six strategies to champion services for older adults, including three that supported the "bottom line" (make the business case; provide numbers; align with system priorities and metrics) and three relational strategies (build visibility and relationships; incorporate patient stories; foster friendly competition).

Our study provides a deepened understanding of how and why healthcare leaders make decisions about resource allocation, as well as six actionable strategies that can help advocates of geriatrics, including those in rural settings, make the most effective business case for bolstering care for older adults.