LDRS 810

Purpose Statement, Central Question and Sub-questions

Chris Payne

The purpose of this case study is to identify whether leaders in managerial roles in a rural

hospital are or at least feel prepared for growth. At this stage in the research, the level of

preparedness will be defined as how prepared the leader feels to manage a department or area

at twice the level of its current capacity. The central question is “Do leaders feel prepared to

lead a group that is twice the size of the current group they’re leading?”. This question will lead

to many sub-questions:

 Do the executive level leaders feel that their managers are equipped to lead when

growth occurs?

 Do the executive level leaders and managerial level leaders agree on their

preparedness?

 What else do managers feel they need to lead well when growth occurs?

 What has already been done to prepare leaders for growth?

The study is focused on leaders in managerial roles at Kearny County Hospital, a rural

hospital that is bucking the trend of most rural hospitals and is growing at an exponential rate.

The hospital has plans for expanding its facilities very soon. One of the largest challenges in

rural areas is a lack of leadership. Many people are simply thrust into leadership positions

because they’ve been in the organization the longest. Most are not offered leadership training

but expected to lead. In an area with more jobs than people, workers who are willing to work

hard and invest in their roles are a rarity.

 A recent survey on growth within businesses showed that 65% worry that growth will

put excessive pressure on operations, damaging quality and customer satisfaction. However,

only 6% of businesses experienced growth within their plans, meaning that growth figures were

either less or more than expected for 94% of businesses. (CFO Innovation Asia, 2016) Applying

that to rural hospitals, which faced a 28% loss nationwide between 1971 and 1998 (American

Hospital Association, 2000), expansion of facilities and adding more staff could be the tipping

the point that either accelerates growth or makes this rural hospital just another statistic.

Previous research on the topic of mid-level management preparedness is nearly non-

existent. Most surveys focus on executive level leadership in business, and in healthcare, the

focus tends to be on providers themselves. However, it would seem that since 32% of people

quit their jobs because they feel they were treated unfairly (Gilbertson ,1998), the lens should

be on those who are leading those who were treated poorly. Were those people treated poorly

by executive level leaders? Unlikely, as managers and mid-level leaders are the ones directly

responsible for the culture within their departments. It would seem to me then, that the

spotlight for employee retention should actually shine on both managers and executive level

leaders.

Also take in to consideration that the primary reason that rural hospitals have such a

high rate of closure was due to the fact that providers no longer wanted to work there

(Kaufman, B. et.al, 2016). Rare are the days of a doctor coming to and staying in a rural

community to serve its population. Rarer still are nurses who will come and work at

understaffed hospitals that offer very few health services. The importance of retaining valuable

health care professionals becomes even more important in these small hospitals. Not only is
recruitment of these professionals important but leading them well becomes even more crucial

in areas like Kearny County so that they will continue to stay.

By studying the expectations of executive level leaders and comparing them to the

expectations and felt needs of the managerial leaders, I hope to either find that they are on the

same page in regards to preparing for projected growth or expose a gap which can be

addressed. With this understanding, hospitals and health care leaders can better understand

how to create a culture in which leaders develop and employees don’t want to leave.

References

CFO Innovation Asia (2016) Study Reveals Most Businesses Are Not Prepared For a Growth
Surge. CFO Innovation Asia; Newton.

Hayes, C. W., Rhee, A., Detsky, M. E., Leblanc, V. R., & Wax, R. S. (2007). Residents feel
unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: A
survey of internal medicine residents*. Critical Care Medicine, 35(7), 1668.

Kaufman, B. G., Thomas, S. R., Randolph, R. K., Perry, J. R., Thompson, K. W., Holmes, G. M., &
Pink, G. H. (2016). The Rising Rate of Rural Hospital Closures. The Journal of Rural
Health: Official Journal of the American Rural Health Association and the National Rural
Health Care Association; Washington, 32(1), 35–43.