Agrarian Ideology Remnants and Rural Healthcare Organizational Behavior: Observations and Research Opportunities

Asa B. Wilson


Rural health facilities, especially hospitals and critical access hospitals, have a troubled history, a challenging today, and a problematic future—a reality that is well documented. Despite public policy support and affiliation tactics, these entities continue to face conversion or closure threats. An enduring question is why these organizations continually struggle. Leading to a hypothesized answer, information gathered during participant-observer turnaround interventions in five rural facilities is categorized, labeled, and interpreted. Five clusters of organizational behaviors were identified. Each cluster is defined in terms of its agrarian root and discussed as a present-day remnant—a rural outlook or mindset. Each behavior cluster is considered in terms of its adverse impact on facility performance. This inductive study points to follow-up studies to: 1) operationalize the rural outlook with a survey tool and a large sample of rural facilities; 2) assess the rural outlook’s association with facility fiscal performance; 3) develop and test an economic behavior theory of the rural healthcare firm; and 4) establish a typology of rural agriculture-based communities. The root cause explanatory value of the rural outlook mindset and the proposed research are discussed in terms of strengthening rural health facilities.

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