Abstract
This Dissertation in Practice provides insights into the lives of rural Nebraska hospitalexecutives. Many researchers have looked at leadership and the struggles that they have
in leadership. Few look specifically at rural healthcare leaders and the struggles of
running a small-town hospital. Living in the perpetual fishbowl is more difficult and can
have greater drawbacks than the large facility executives have. The financial outcomes
are more difficult to produce, and the high rates of patients with Medicaid coverage can
make it impossible at times. This study highlights both the challenges along with the
tactics that have facilitated success for those rural executives. Some of the key themes
highlighted in the study include: rural living, recruitment, leadership team/culture, and
operations/governance. Recommendations from the study include building facility and
community buy-in to the value of the hospital, along with bottom-up board education.
This study’s findings could help a new executive to understand and navigate the common
pitfalls that are shared by other executives.
Keywords: Leadership, rural, culture, executive, influence