Rural hospitals' size may be an advantage in a pandemic

Summary of rural hospital advantages and related policy recommendations
(Health Affairs chart; click the image to enlarge it)

Rural hospitals have had a difficult time with staffing during the pandemic: fewer staff to begin with, losing staff to lucrative traveling nurse jobs, and overworked, stressed-out staff overall. But that may not be the whole story, five health-care experts write for Health Affairs.

"Despite the many challenges rural hospitals experienced during the pandemic, our interviews revealed that rural hospitals’ small size and connectedness with their workforce and community gave them distinct advantages with respect to the speed of decision making and action, communication with their workforce, and flexibility," they write. "Interestingly, staff issues relating to flexibility, quality of relationships, and organizational culture were all seen as particular strengths of the rural setting."

Such advantages can help mitigate staffing challenges, the experts found through extensive interviews (funded by the Agency for Healthcare Research and Quality) with rural hospital employees. They recommend policy actions (see chart above) to help leverage those advantages.

They found that rural hospitals' smaller size means staff are more likely to wear many hats in their everyday work, making them more flexible and adaptable in an emergency such as the pandemic. Their size can foster a close-knit staff who trust each other, and are more likely to help in a crisis regardless of job title. Also, the more intimate setting can make for better communication, the surveys found.

Rural hospitals can also have outsized influence in leading and shaping emergency response systems in their overall communities. Two of the experts are emergency-medicine specialists in Minnesota and Massachusetts, and another is an emergency-management consultant. The others are Ph.D.s at Harvard and Stanford universities.