Date of Conferral



Doctor of Healthcare Administration (D.H.A.)


Health Services


James E. Rohrer


Rural hospitals treat patients while dealing with the challenges of an inadequate workforce, limited financial resources, and an isolated geographic location, leading to difficulties in achieving financial viability. The purpose of this quantitative study was to analyze the operating performance of rural, general, medical and surgical hospitals in the United States and to determine if performance had changed from 2012 to 2019. Guided by x-efficiency theory, this study addressed whether hospital ownership explained variation in performance and if performance had changed from 2012 to 2019. A random sample of 394 rural hospitals was used, with data drawn from the American Hospital Association Guides for 2012 and 2019. A 2-step method of analysis that included both data envelopment analysis and linear regression was employed to generate the findings. The results of this study revealed that ownership was not associated with performance scores in 2012 and weakly associated with performance in 2019. Performance scores did not change over time. The implications for social change include the need for rural hospitals to modify structures and operations to improve efficiency while increasing services, access, and operations to their patients.