History of Hospital B
Hospital B is a for-profit, small institution (between 1-49 beds) providing acute care, general services to the Mountain West region. It is part of a for-profit system that is one of the largest owners and operators of hospitals in non-urban communities in the US. Hospital B was founded over 100 years ago by medical personnel merging private hospitals. The hospital was originally based out of a church building. Later another church donated a larger building as a new site, which remains part of the hospital's structure today. In the 1980s, the hospital was sold to a for-profit health system before it came under the ownership of its current system.
This hospital is designated a Sole Community Hospital, which means it is a small hospital that provides rural populations with access to a wide range of health services. Hospital B's closest competitor is an equally small, non-profit hospital located over 30 miles away. Positioned in a more open regulatory environment, Hospital B's home state has no certificate of need program. The market is mixed, but the state ranks among the top 10 states with the largest percentage of all hospitals being for-profit.
Hospital B is in a majority white, rural community with residents who have low-mid socioeconomic status and low educational attainment. The town has a population with fewer than 10,000 residents. The average resident is between 25-35 years old, almost equally likely to own their own home as not and has an average household income between $30,000-$50,000.
"Belt" regions of the US are regions of the country that share similarities. In this case, the state is situated within a larger cultural region that is more socially conservative and where residents are more likely than the average US citizen to affiliate themselves with a religious tradition. Hospital B did not formally align itself with a religion when founded. It does not have a religious affiliation currently and neither does its system.
Hospital B as an Anchor Institution
Most rural hospitals are owned by nonprofit systems. Hospital B provides an opportunity to examine a for-profit, rural hospital as an anchor institution. A hospital in a rural area typically has less competition than in an urban market due to a smaller population; thus, it has a more limited patient base. Lack of alternative institutions for health and non-health related community support may strengthen the interconnectedness of a rural hospital with the surrounding community.
Leadership at Hospital B is highly motivated to act as an anchor institution. Hospital B had a change in executives within the last several years. Incoming leadership surveyed hospital administration to gauge the level of involvement in community engagement and outreach. Incoming leadership used the survey to identify areas for improvement, like supporting charity care programs, and meeting regularly with fellow anchor institutions, such as first responders, to coordinate care during major events. Social responsibility in a small town was also raised by staff as motivation for Hospital B’s anchor-like activities. Staff point to the importance of centralizing patients’ healthcare by expanding Hospital B’s range of healthcare services to preclude patient travel to receive specialty care. Community benefit programs are likewise “the right thing to do” in a small town where hospital personnel and residents pride themselves on responsiveness to needs at the hospital or within the community.
Along with social responsibility, staff cites economic incentives as a motivation for anchor activities. Hospital B’s goal to expand the health services available locally keeps revenue circulating through the local economy. Initiatives like donations of funding, equipment, and scholarships to local universities support medical personnel training programs, whose graduates may staff Hospital B. In addition, Hospital B’s participation in community benefit programs raises awareness amongst the community about the hospital’s services.
Hospital B’s anchor activities include but are not limited to providing healthcare services. The hospital provides substantial employment in the region. One in ten workers is employed in the healthcare/social assistance industry. The hospital also provides sponsorship, equipment, and volunteerism for annual community events, supporting the arts, sports competitions and leagues for all ages, holiday celebrations, charitable fundraisers, and school programs.
Barriers to community benefit programs are limited funds and organizations who decline to participate in partnerships. Staff expressed support for a community benefit inventory in order to learn how peer hospitals are approaching community benefits and to increase the visibility of Hospital B’s community outreach and engagement amongst community members, the general public, and policy makers.
- Hospital sponsors a rodeo, charity auction, local secondary and higher education, a triathlon, high school and community plays, holiday celebrations, a singing competition, Little League sports, Tough Enough to Wear Pink, charity adult sports tournament, the orchestra and symphony.
- Hospital partners with the state hospital association, fire department, police, K-12 schools, and Boy Scouts.
- Hospital supported local business by purchasing fabric and asking community members to sew masks.
- One of the largest employers in the community.
- Employees donate time at first aid stations at community events.
- The CEO surveyed hospital leadership about community engagement and used the survey to identify gaps in engagement. Initiated quarterly meetings with Fire and Police departments to coordinate care for community disasters.
- Leadership volunteers time at the state hospital association, county political party, Little League.
- Leadership serves on boards for local colleges and universities, youth sports organizations, Chamber of Commerce.
- Employees serve as coordinators for events like Boy Scout breakfast and Women’s Day Out.
- Hospital purchased scoreboards and first aid kits for the local high school.
- Hospital funds scholarships for high school students and hospital employees.
- Hospital funded establishing a medical lab for the local university and donates yearly to run the program at the lab.
- Hospital hosts summer activities and hospital tours for elementary children.