HJAR May/Jun 2021

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2021 51 Mellie Boagni Bridewell Chief Executive Officer Arkansas Rural Health Partnership Potential solutions and recommendations for rural hospital board of directors include: • FOCUS ON BOARD LEADERSHIP . Having a board that is informed on healthcare finances, trends and processes can help them provide informed support to the CEO. Implementing and/or mandat- ing educational and training initiatives from an experienced, knowledgeable organization could be an option for board members upon being appointed and/or on an ongoing basis. • IMPROVE THE VETTING PROCESS . Ahos- pital board should know what kind of leader they need and what qualities they are looking for before starting a search. By knowing and recogniz- ing the specific gaps and needs of the hospital and board, search committees would be better informed of what kind of leader/board member they need to hire/appoint. • SET CLEAR EXPECTATIONS. Provide a quality annual performance review and touchpoints throughout the year. Utilization of third-party data and con- sultations are necessary to provide a buffer between the board and CEO, al- lowing for mediation when there are disagreements in compensation, phi- losophy, wage scales, etc. • PROVIDE OPPORTUNITIES FOR GROWTH. Much like physicians need continuing education to stay on top of new and emerging methods of care, CEOs need time with their peers to discuss what others have found successful and what pitfalls they might encounter within their own organization. Boards should encourage CEO participation in com- munity boards and organizations, as well as state hospital associations, burnout and noncompetitive compensation. The struggle of the rural hospital is real. “Hospitals and health systems continue to evolve to meet the changing needs of the health care environment,” says Deborah J. Bowen, FACHE, CAE, ACHE’s president and CEO. “Organizational restructuring, the movement of CEOs to different posi- tions within health systems, and the fact that many CEOs are reaching retirement age all contribute to this high level of turnover in hospital CEO positions. Succession planning for C-suite positions, along with a focus on developing the next generation of leaders, is key to organizational success.” Succession planning in rural areas is made even more difficult by the size of the organization. Rural facilities require their employees to “wear multiple hats,” some- times even the CEO. Attempts of succession planning to train a replacement are limited by workforce numbers. As rural hospitals move toward requiring a master’s degree or 7 to 10 years of experience, the pool be- comes even more limited. Rural hospitals have limited infrastruc- ture, resources and leadership compared to urban hospitals. Therefore, losing a rural hospital CEO can have a negative effect on the entire operation of a hospital. If there is a shake-up at the leadership level, the community questions the viability of the hospital. Personal experiences from rural hospital CEOs include: • RECRUITMENT TIME IS LENGTHY AND EXPENSIVE. Losing a hospital admin- istrator can be catastrophic to a small rural hospital, both operationally and financially. Since there is often not qualified staff at the hospital or in the community to take on a leadership role, recruiting is usually accomplished by contracting an outside resource to as- sist with the process. Recruiting firms can be expensive and often result in failure due to the incompatibility of prospective candidates. • COMMUNITY PARTNERSHIPS AND ALLIANCES CAN CHANGE . It is very common for a leader to bring on his/ her own team when hired. When this leader is removed or leaves there is always uncertainty about what will happen next, who will remain, and who will be asked to leave or step down. This situation can cause stress throughout the staff and community. With each new administrator comes change. • COMMUNITY BECOMES UNSURE OF THE STABILITY OF THE HOSPITAL AND LEADERSHIP . When a rural CEO is removed, there is more than likely talk around town of the struggles of the hospital. This is because if a rural hospital CEO is asked to leave or removed from his/her position, it is because the hospital is in financial distress or not doing well. Administrators are rarely asked to leave if the hospital they are running is doing well financially. This uncertainty can often cause feelings of distrust and lack of confidence in the ability of the hospital to provide adequate service among the public. The departure of a rural hospital CEO can cause cost cutting, service closures, and staff reductions, as well as halt growth and devel- opment activities, such as construction proj- ects, the purchase of new equipment, and strategic planning. Rural hospitals can im- plement procedures and processes that can help with preventing future CEO turnover.