A multi-method analysis of the tangible and intangible advantages and disadvantages of delivering surgical services in small rural hospitals: Future prospects, challenges and opportunities

Small rural hospitals in the United States are challenged by evolving changes in their roles as providers of care to rural residents and as economic resources for surrounding communities. This study examined surgical services in small rural hospitals throughout the United States in micropolitan (micro) and rural areas. Uncovering the determinants of successful surgical services in small rural hospitals was the main focus of this dissertation, with specific emphasis on gathering data to help executive staff members decide whether to maintain, enhance, or discontinue their surgical services program.;A multi-method study design was utilized with qualitative (case study) and quantitative (survey) methods. The qualitative study included in-depth interviews with executive and clinical staff at Pauls Valley General Hospital, located in Pauls Valley, Oklahoma. The quantitative study included a 35-question survey distributed to 246 hospitals with 40--55 beds set up and staffed in micro and rural areas throughout the United States. The overall survey response rate was 44 percent. Statistical analysis included the use of Chi-Square, ANOVA, and multiple regression. The multi-method approach allowed for a deeper exploration of the research questions and confirmation of consistencies between the two methodologies.;The findings were consistent with current literature and demonstrated that small rural hospitals want their surgical services program to survive and would like to add surgical procedures. This is a challenging endeavor considering the data showed the number of authorized licensed and set up and staffed beds decreased significantly from 2003 to 2008. In addition, this study verified the need for increased attention to the recruitment and retention of general surgeons and clinical support staff. Collectively, the economic, care delivery, and organizational aspects of providing surgical services were all vital factors and explained over 60% of the variance in the success of small rural hospitals' surgical services.;Small rural hospitals need to focus on community ties, add new surgical service lines, emphasize outpatient surgeries, and implement recruitment and retention strategies. The outcomes of this study should be helpful to executive staff members and those interested in further exploration and identification of new methods to increase the survivability of small rural hospitals.