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Community perceptions and commitment affect the survival of rural hospitals

Hospital mergers and closures have become a fact of life in the era of managed care, particularly in rural areas. However, because hospitals are socially embedded in their communities, they cannot abandon their mission without damaging links within the community. In fact, the viability of a rural hospital is affected by the community's perception of its importance and legitimacy, as well as commitment to its existence, contend William A. McIntosh, Ph.D., and Dianne Sykes of Texas A & M University. Their research on the survival of rural hospitals, which was supported by the Agency for Health Care Policy and Research (HS08247), is described in a recent book chapter and journal article, summarized here.

McIntosh, W.A., Sykes, D., Segura, C.B., and Alston, L.T. (1999). "Rural hospital survival: A case study of the shaping effects of community perceptions," in Research in the Sociology of Health Care, Greenwich, CT: JAI Press, pp. 34-56.

The researchers studied two rural Texas hospitals that participated in a project on the adoption and use of telecommunications for rural health care. They analyzed articles from local newspapers about the two hospitals over an 18-year period and interviewed hospital administrators, physicians, and influential people in the two communities about the hospitals' mission, history, and reputation in the community.

Both rural hospitals serving these two communities suffered severe financial difficulties and lowered quality of care during the 1970s and 1980s. But the community commitment to the hospitals differed markedly, which in turn affected hospital survival. One hospital was viewed as the only local hospital and a necessary institution. This view overshadowed the very real quality of care issues and induced the community to commit itself to positive action on the hospital's behalf. The result was a hospital that now provides better care for the community and surrounding counties. In contrast, the other rural hospital was surrounded by counties with similar community hospitals and a divided medical community. This community paid relatively less attention to its hospital's plight, with the daily newspaper focusing more on its problems and failures than successes. Despite an innovative telecommunications outreach program, this hospital finally closed.

Sykes, D., and McIntosh, W.A. 1999. "Telemedicine, hospital viability and community embeddedness: A case study." Journal of Health Care Management 44(1), pp. 59-71.

Like other hospitals, rural hospitals often struggle to remain competitive by adopting medical technology or expanding hospital services. However, innovation alone may not be sufficient for them to remain viable, according to this case study of one isolated, financially struggling rural hospital. In 1990, this West Texas hospital became the primary site of an innovative telecommunications project known as MEDNET.

Both satellite communications and special telephone lines were used to establish links with several rural West Texas hospitals. The goal of the 3-year project was to increase rural hospital viability by decreasing the isolation felt by rural physicians, helping health care professionals retain their certification without leaving the area, and providing physicians with support in diagnosis and treatment through access to specialists via interactive video. Despite the potential of telecommunications to improve the health of the community and help the hospital survive, the hospital's relationship with its local community remained tarnished by a history of financial problems and conflict that could not be overcome by MEDNET.

Throughout the MEDNET years, the local newspaper presented the project as a program created and operated by Texas Tech University's Health Sciences Center. The role of the local hospital and physicians was for the most part overlooked. This may have been a factor in the project's inability to stabilize hospital finances or alter community perceptions of the hospital. If lives were saved or doctors felt a little less isolated, such events were not recorded in the local newspaper. Savings from expert consults were estimated to be nearly $1,000 per patient, and summary reports indicated increased patient volume and local confidence in the hospital. Again, these accomplishments were not publicized and did not help the hospital survive, note Ms. Sykes and Dr. McIntosh.

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