Introduction: The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Methods: Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Results: Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data related to poverty, county demographics, and the percentage of the population insured, a relationship between the proportion of the population over 65 years, the percentage of the population living in poverty, the percentage of the population without insurance and county density was found. Conclusion: The results of the analysis suggest that hospital employment in rural communities is higher than would be expected in the absence of programs that provide external funding to support hospital hiring. The most important public programs providing this support are Medicare and Medicaid. Social Security is another source of federal funding important for rural populations. Sequestration and other cuts in funding could impact rural communities significantly. This can be even worse in states that fail to expand Medicaid and in states that fail to increase Medicaid reimbursements for services important in rural communities.

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Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement EHRs. The focus of this descriptive phenomenological study was to explore lived experiences of hospital leaders and administrators who have used successful strategies to implement EHRs in small rural hospitals. Diffusion of innovation theory shaped the theoretical framework of this study. Data were collected through telephone interviews conducted with participants who successfully deployed EHRs at 10 hospitals in the Appalachian regions of Maryland, Virginia, and West Virginia. Data analysis occurred using a modified Husserlian approach in search of common themes from interview transcripts. The main themes were strategies to address standards and incentives, implementation, and challenges. The exploration of these strategies provides insight that small rural hospital leaders and administrators could consider for implementing EHRs. The study findings might enable small rural hospital leaders and administrators to contribute to positive social change by engaging communities in using EHRs; these findings may also expand information sharing among individuals and organizations and build social relationships with an expectation of future benefits. Results from this study are designed to inform other small rural hospital leaders and administrators to conduct further research on successful strategies for implementation of EHRs.

This qualitative research focused on the emergency preparedness (EP) rule implementation in rural hospitals in the Pacific Northwest. A new law has been implemented that requires hospitals to comply with Medicaid and Medicare law. Learning about the implementation and preparedness process could help rural regions in the Pacific Northwest better prepare for emergencies and comply with the law. The purpose of the study was to gain increased understanding of how the new EP rule of 2016 impacts rural hospitals' preparedness in the Pacific Northwest. The theoretical framework was complexity theory. This study focused on the lived experience of emergency managers who have been working on the implementation of the new EP rule in rural hospitals in the Pacific Northwest. Using a phenomenological approach, 8 in-depth phone and face - to - face interviews were conducted. Selection criteria included working as emergency preparedness managers in rural hospitals in the Pacific Northwest. The verbatim transcripts of interviews were analyzed by first cycle analysis, used concept and descriptive coding to find common themes. The findings of the study included that small rural hospitals working on EP need more support and help that include financial needs, resources, staff preparedness improved communication and more exercises local communities including every individual living in the community are also responsible for their own preparedness. This inquiry could help understand the effects of the new EP rule for rural hospitals; it could identify gaps in research that could support rural hospitals and surrounding communities; it could affect positive social change by applying the research evidence to additional health care settings.

No description available.

In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital documentation and pertinent strategic information from their respective semistructured interviews. Sections of text signifying concepts from collected documentation and transcribed interviews were organized and coded according to research question and interview questions to explore strategies rural hospital leaders implemented to improve their hospital's financial performance. The methods triangulation process encompassed comparing findings from the interview themes and hospital strategic documentation analysis. The key themes that emerged from coded data were rural hospital leaders' decision-making when addressing rural hospital financial performance, developing synergies with external providers and hospitals, creating effective short-term and long-term strategies, and translating success to the entire organization. Implications for social change include the potential to prevent rural hospital closure and ensure access to healthcare services for the communities rural hospitals serve.

Thesis(MPH.) -- University of Limpopo, 2019 / Background: Community service health professionals working in rural areas experience challenges such poor accommodation, poor supervision, unavailability of equipment and medication. The majority of studies focussed on doctors, with a few including dentists and pharmacists. This study intended to establish the experiences of community service health professionals in all professions. Objective(s): The objectives of the study were to describe and explore the experiences of community service health professionals. Methods: A qualitative, exploratory and descriptive study was conducted. Purposive sampling was used to select community service health professionals for the study. Face to face interviews with community service health professionals were conducted to collect data. Community service health professionals were interviewed until data saturation was reached. The Tesch‘s eight steps were used to analyze data. Results: The study findings indicated that community service health professionals experienced challenges relating to accommodation, supervision and unavailability of equipment and medication. Conclusions: Community service health professionals are experiencing challenges regarding working in Limpopo province rural hospitals. It is recommended that the government should allocate more funds to health care services to address the challenges faced by community service health professionals

Submitted in compliance with the requirement for Degree of Doctor of Technology: Radiography, Durban University of Technology, 2013. / The shortage of radiologists in Zambia has persistently made the provision of equitable access to optimum radiological services unattainable in the current radiological service delivery system, while equity in distribution of cost-effective and quality healthcare service as closer to the community as possible is at the core of Zambia’s vision in the National Health Strategic Plan. This vision is maintained in Zambia’s Sixth National Development Plan, for the period 2011 to 2015. The number of radiologists as low as three radiologists, for a population of thirteen million people, makes the possibility of ever providing optimum radiological services equitably accessible to the community unattainable, without launching and upholding a precise remedial intervention. The purpose of the study was to develop a framework for sustainable radiographic human capital developmental guidelines embracing advanced radiographic practice and optimum radiological services, with special focus on hospitals without radiologists. The objectives were to: a) analyse the existing radiographic services and/or practices in rural Zambian hospitals without radiologists; b) examine the views of radiographers, physicians, and patients in hospitals without radiologists, regarding adequacy of radiological service delivery; (c) determine desirable competencies for frontline radiographers in comprehensive radiological service delivery, as well as the benefits of such competencies to the community and the health service facilities; d) analyse the healthcare managements’ expectations regarding frontline radiographers’ capabilities in rendering comprehensive radiological services in healthcare settings without the radiologists, e) formulate, implement, and evaluate a training programme for radiographers for comprehensive radiological services; with specific references to client (physician and patient) satisfaction and radiographic competencies; and (f) develop a framework for human capital development for frontline radiographers in providing comprehensive radiological services. The Accenture Human Capital Development Framework (AHCDF) was employed as the theoretical framework to link all key aspects of the inquiry (Thomas, Cheese and Benton, 2003). An Action Research design was used involving multidisciplinary participation, including patients, in the five cyclical phases of the Action Research design; diagnosing, planning, acting, evaluating, and specifying learning. The route of knowledge generation and application was guided by retroductive or abductive cyclical logical process. The interviews, document analysis, and questionnaires were applied to obtain data, whereas a designed training programme for frontline radiographers was piloted and evaluated within this study. The study’s data management and analysis were largely by qualitative methods, though quantitative aspects involving percentages as in descriptive statistics were also involved where appropriate. The discussion, integrates the research findings under appropriate themes of the theoretical framework. An investment perspective in AHCDF is linked to ways of investing in radiographers’ education and training towards extended roles is discussed. The radiographers’ extended roles are seen as a catalyst to desirable radiological technology, radiological service designs, and corresponding radiological service outcome. The benefit of this proposed investment is seen as promoting equitable access to radiological services, with averted or reduced costs ascribed to referrals of patients among hospitals. Consequently, incomes of households and healthcare institutions would be preserved for poverty reduction by reduced referral-related costs. The researcher-devised frontline radiographic human capital developmental (FRHCD) conceptual framework is developed and a way forward recommended. / African Doctoral Dissertation Research Fellowship International Development Research Center (IDRC) Ford Foundation

The formation of multi-hospital systems represents one of the largest structural changes in the hospital industry. As of 2008, system affiliated hospitals outnumbered stand alone hospitals 2511 to 2167 and the percentage of system affiliated rural hospitals has increased dramatically from 24.8% in 1983 to 42.2% in 2008 (based on AHA data for non-federal acute care general hospitals). The effects of system membership on hospital performance have been of great interest to health care researchers, but the majority of research on multi-hospital systems has either focused exclusively on urban facilities or pooled urban and rural facilities in the same sample, and thus failed to allow for potential differences in membership effects between urban and rural hospitals. The result is that the effect of system membership on rural hospital performance has remained largely unexplored, creating a gap in the body of health services research. The objectives of this study are both theoretical and empirical. Theoretically, this study is intended to be a deliberate empirical application of contingency theory, which is the one major organizational theory that seeks to explain variations in organizational performance as its fundamental purpose. Empirically, this study seeks to explore the relationship between rural hospital system membership and rural hospital performance, taking into account the environment of the rural hospital and the structure of the multi-hospital system to which it belongs. The study sample consists of 1010 non-federal, short-term, acute care general rural hospitals with consistent system membership and critical access hospital (CAH) status from 2004 to 2008. Hospital economic performance is represented by the dependent variables of hospital total margin and a productive efficiency score calculated using Data Envelopment Analysis (DEA). Four contingent pairs containing measures for environmental munificence, system membership, the presence of local system partners, the presence of hierarchical system partners, and CAH status, were used to measure a hospital’s fit between environment and structure. Regression analysis was used to determine the relationship between hospital performance and the fit between a hospital’s environment and its organizational/system structure. Results of the analysis indicate that hospitals with a better fit have significantly higher total margins, but results for productive efficiency were largely insignificant.

Darbo tikslas. Atskleisti gydytojų požiūrį į motyvavimą dirbti rajoninėse sveikatos priežiūros įstaigose. Uždaviniai. 1. Išskirti pagrindinius veiksnius, susijusius su gydytojo darbo rajono sveikatos priežiūros įstaigoje pasirinkimu. 2. Atskleisti problemas, su kuriomis susiduria gydytojai, neseniai pradėję dirbti rajoninėse sveikatos priežiūros įstaigose. 3. Išsiaiškinti gydytojų nuomonę apie priemones, kurios yra taikomos arba galėtų būti taikomos siekiant pritraukti ir išsaugoti gydytojus dirbti rajonuose. Tyrimo metodika. Taikant kokybinį tyrimo metodą, giluminio interviu būdu, apklausti 8 Lietuvos rajonų sveikatos įstaigose dirbantys gydytojai rezidentai ir 3 neseniai (iki 3 metų) rajonų gydymo įstaigose pradėję dirbti gydytojai. Rezultatai. Dirbti į rajonines sveikatos priežiūros įstaigas vykstama dėl mažesnės konkurencijos darbo rinkoje, didesnių atlyginimų. Gydytojai apie darbo vietas sužino skambindami patys į ligonines arba per turimus ryšius. Rajoninės įstaigos motyvuoja gydytojus atvykti dirbti į rajoną finansinėmis ir nepiniginėmis priemonėmis, siūlant didesnį atlyginimą, rezidentūros apmokėjimą, palankų darbo grafiką atvykstančiam gydytojui. Universitetų priemonės vertinamos negatyviai, nes yra netiesioginis dėstytojų ir gydytojų nuteikimas prieš darbą rajone, nėra sudaromos sąlygos studijų metų padirbti rajone. Gydytojas rajone įgauna žinių ir praktinių įgūdžių atlikdamas įvairesnių procedūrų, kartais srityse, kurios yra už jo kompetencijos ribų. Rajoninėse... [toliau žr. visą tekstą] / Aim of the study. To identify and analyze the doctors’ motivation aspects to work at hospitals in the rural areas. Objectives. 1. To identify the main factors that influence the doctors’ decision to work at hospitals in the rural areas. 2. To determine the problems that doctors are facing in their beginning at work in the rural areas. 3. To investigate the doctors’ opinion about the instruments that were used or could be adopted in practice to attract and retain doctors in rural hospitals. Methods. Qualitative study was used to get the information which contains motivating factors for doctors to work at the rural hospitals. Using in-deph semistructured questionnaires were asked 8 residency students and 3 doctors at rural hospitals. Respondents were selected using short (less than 3 years) working period in rural hospital criteria. Results. Lower competition in labor market and higher salaries are the push factors for doctors to choose the rural workplace. Most of the doctors request the hospitals directly for the vacant positions or get the information about available positions from people they know. Rural hospitals attract doctors with higher wages, refund the payment of residency studies and adjust a better working schedule. The incentives of universities should be better developed because there is lack of rural practice possibilities for the students. There is indeed strong influence made by lecturers who spread negative and inadequate approach about rural hospitals... [to full text]