Rural hospital, board changes demand new executive leadership.

Changes in rural hospitals, their boards, and the potential administrative work force have resulted in an increase in experienced, educated healthcare administrators relocating to rural institutions. Rural quality of life, a competitive healthcare environment that demands competent executives, multi-institutional systems replacing rural freestanding facilities, and a saturated urban market have contributed to this shift. Major conflicts of interest between rural boards and executive candidates kept many administrators from choosing rural positions 15 to 20 years ago. Most candidates had an urban background, were dissatisfied with rural salaries, and saw little chance for a sustained challenge, career development, or peer contact. Rural boards saw no great need for executive leadership or formally educated administrators, and they generally distrusted outsiders. Today rural boards have assumed more progressive recruitment methods, comparable with those of urban boards. They cite the importance of a health and business educational background, although candidates' academic records, affiliations, and memberships are less important. Rural chairpersons use well-established criteria in determining prospective administrators' strengths and weaknesses.