Date of Conferral







Richard Schuttler


Over 80 rural hospitals have closed in the United States since 2010, representing about half of all hospital closures during this period, and another 600-700 rural hospitals are at risk of closing shortly. The purpose of this qualitative exploratory multiple case study, which was based on transformational leadership and diffusion of innovation theories, was to gain a common understanding of financial problems and operational inefficiencies that may be impacting rural hospital leaders in the state of Texas. Data collection involved semi-structured interviews with 4 senior healthcare leaders from 3 separate regions in Texas. Data analysis included compiling, sorting, fragmenting, and reassembling of the data into 19 common themes. The 4 most common themes included poor payer mix and uninsured population, inconsistency with evidence-based measures, costs of providing care exceeding reimbursement, and the movement of inpatient procedures to outpatient. The study findings may help advance the practice of leadership in both rural and urban healthcare. This study may contribute to positive social change by creating awareness of how rural hospitals are in danger of closures, and how these closures can affect urban hospitals and overall quality of life for rural Americans.