Transformational Leadership: A Vaccine for Rural Healthcare Delivery

July 23, 2020 | Benjamin Anderson

During the early spread of COVID-19, the National Rural Health Association senior vice president Brock Slabach stated, “Before the pandemic, rural hospitals were struggling for survival. COVID-19 has put a spotlight on the fractures that already existed within rural communities in terms of their healthcare delivery.” These fractures also exposed the desperate need for ethical transformational leadership within rural healthcare delivery systems. The time to build these capacities is now.

What is a transformational leader?

Transformational leaders influence positive change in individuals and social systems. They enhance the well-being and performance of followers. They leverage relationships to bring differing people together, guiding them to create a vision for a future desired state. They build consensus and collaborate. They understand the difference between knowing what to do and ensuring it is done well. They are flexible and adaptable, self-confident but not arrogant and possess a strong, selfless social conscience. They must be a guiding north star during turbulent times. This is especially true in rural America during COVID-19.

How can transformational leadership drive health equity?

Change can be very difficult for people, even crippling. COVID-19 has brought out both the best and the worst in our healthcare delivery system as states and communities adapt to this new, seemingly ever-changing environment. The virus and its social implications (e.g., homelessness, poverty, unemployment, hunger) disproportionately affect certain ethnic groups and socioeconomic classes—it also shines a light on inequities that require total transformation of how we deliver care and target resources. Different than tactical leaders, effective transformational leaders shepherd necessary changes by ensuring stakeholder buy-in. They know the foundation of the future of our society is healthy, productive, and resilient people—and that includes all of us.

Transformational leaders should possess an insatiable social conscience and an intuitive ability to identify “the right thing to do,” and relentlessly pursue it. COVID-19 has only deepened health disparities in the United States as certain ethnic groups are more commonly employed in service jobs, affecting unemployment rates. The life circumstances of these same groups—like often living in close quarters with others—make social distancing difficult or impossible, leading to disproportionate infection rates. These dynamics exist in rural communities, especially in areas where feedlots and packing plants are present. These communities may be more vulnerable than their urban counterparts because of their geographic distance from critical care services and their position at the end of the traditional supply line for healthcare materials. Solutions to problems like these require innovative public-private partnerships.

When transformational leaders are perplexed by thorny problems, they source ideas from people who work closest to the issue. They further analyze common measures, separating them by group to uncover disparities. They intuitively innovate and collaborate to “hack systems” that ensure the achievement of more equitable outcomes. They document processes to expand and maximize the impact of those efforts.

In Colorado for example, a partnership called #Heart4Heroes was formed between several safety net associations, health foundations, the governor’s personal protective equipment (PPE) taskforce, Project C.U.R.E., Angel Flight West, the Colorado Civil Air Patrol, and a company called Perfect Image to “hack the supply chain,” procuring over 250,000 pieces of PPE and delivering them to hospitals and providers in rural Colorado. These efforts were coordinated with the state emergency operations center. The National Rural Health Association is working to scale this effort nationally.

How could state health officials partner with hospital leaders to build transformational leadership in rural communities?

Rural healthcare has suffered because of a lack of transformational leadership, resulting in compromised stewardship of financial resources. At the pace that the healthcare industry is changing, especially with the arrival of COVID-19, effectively managing these resources in a shifting environment is essential for the survival of rural healthcare.

To start, consider the efforts across the nation for building our primary care workforce. We identify students who are gifted in the sciences and encourage them to enroll in certain pre-medicine programs. We shepherd them into rural training tracks in medical schools and nudge them toward residencies with broad or full-spectrum training. We offer loan repayment and other incentives for them to begin their careers and lives in rural communities. In contrast, our efforts to train rural administrative leaders are sparse and inadequate. Often, a department manager with tenure is appointed to a hospital CEO position, sometimes without the tools to lead well.

Policymakers could collaborate with hospital associations to develop rural training tracks for transformational administrative leaders. They could identify aspiring leaders currently living and working in rural areas and send them through graduate level programs that specialize in transforming community health and healthcare delivery.

Among the most elite programs offering this virtual education are the University of Texas’ Master of Science in Health Care Transformation and Dartmouth College Master of Health Care Delivery Science. Both programs prioritize geographic diversity and accomplished rural applicants. These students could be organized into cohorts, where they are able to share how they are applying this knowledge in their various communities. Scalable ideas tied to improved outcomes and lowered costs could be considered for funding opportunities.

Health officials and hospital associations could also partner to develop rural administrative fellowship programs, where fellows rotate through high-performing hospitals in rural and underserved communities, while being mentored by those leaders and learning to empathize and partner with clinicians. There could be financial incentives working in rural and underserved areas.

Our society’s financial investment in healthcare is already significant. Our challenge is to steward those financial resources well, which requires competent, ethical, transformational leadership. A relatively small investment and some innovative, collaborative partnerships between state health officials and hospital associations would make a significant impact on transforming the future of rural healthcare in the United States.

The development of this document is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UD3OA22890.