Keeping the Small-Town Hospital Going: How External Obstacles Affect the Ability of Practices to Improve

Cheryl Crichley, Practice Facilitator Coordinator, Southeast Region, Oklahoma Cooperative


I recently met a physician on a practice visit who seemed to be keeping his small-town hospital alive almost single-handedly, while also running his own small practice. The practice office manager told me he had spent the entire previous night at the hospital staffing the ER before coming to work at his own clinic. He does this often, as well as doing nursing home visits. The lone physician puts in this extra effort and time to keep the small, rural hospital going, on top of his own practice, because of what could happen if the hospital closes. Not only would his patients have to go farther for care, but he and other clinicians would have to go farther to do hospital rounds. This would take time away from seeing their own clinic patients, adversely affect the ability to recruit clinicians to the region, and keep them from improving their practice’s cardiovascular preventive services. Sometimes the best efforts of a facilitator can be stymied by such external stressors. Practices are not isolated from the world, and unless the facilitator is aware of external factors, it may be easy to become frustrated with a practice for not engaging in quality improvement work rather than working with them in their context.

rural graphic 1