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The Survival of Healthcare in Rural Texas

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The Survival of Healthcare in Rural Texas Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 The urS vival of Healthcare in Rural Texas Destin Cook Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Business Administration, Management, and Operations Commons, Health and Medical Administration Commons, and the Management Sciences and Quantitative Methods Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Management and Technology This is to certify that the doctoral dissertation by Destin Cook has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Richard Schuttler, Committee Chairperson, Management Faculty Dr. Jean Gordon, Committee Member, Management Faculty Dr. Sheryl Kristensen, University Reviewer, Management Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract The Survival of Healthcare in Rural Texas by Destin Cook MBA, Colorado Technical University, 2013 BS, Colorado Technical University, 2011 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Leadership and Organizational Change Walden University August 2018 Abstract 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. The Survival of Healthcare in Rural Texas by Destin Cook MBA, Colorado Technical University, 2013 BS, Colorado Technical University, 2011 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Leadership and Organizational Change Walden University August 2018 Dedication The dedication of my dissertation goes to my wife, Carrie, for her endless prayers and encouragement throughout this doctoral journey; your support helped push me to deliver the best possible work. I would also like to dedicate my work to my children, Ethan, Jacob, Addison, and Kinsley, who gave me plenty of distractions, just when I needed them. Acknowledgments I would like to express my sincere gratitude for my chair, Dr. Richard Schuttler, who not only mentored me through the entire process, he also ensured that I fully understood scholarly tone and the meaning behind his incremental gains philosophy. I would also like to thank my committee member, Dr. Jean Gordon, who helped get the quality of my work to a higher level. Thank you both for your guidance and support. Table of Contents List of Tables .................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Background to the Problem ...........................................................................................2 Problem Statement .........................................................................................................5 Purpose Statement ..........................................................................................................6 Conceptual Framework ..................................................................................................6 Research Questions ........................................................................................................7 Nature of the Study ........................................................................................................8 Definitions......................................................................................................................9 Assumptions of the Study ............................................................................................10 Scope and Delimitations of the Study ..........................................................................10 Limitations of the Study...............................................................................................11 Study Significance .......................................................................................................12 Significance to Practice......................................................................................... 12 Significance to Theory .......................................................................................... 12 Significance to Social Change .............................................................................. 13 Summary and Transition ..............................................................................................13 Chapter 2: Literature Review .............................................................................................15 Literature Search Strategy............................................................................................16 Conceptual Framework ................................................................................................17 Historical Overview .....................................................................................................18 i Organizational Leadership ...........................................................................................22 Transformational Leadership ................................................................................ 26 Systems thinking ................................................................................................... 28 Systems thinking in Healthcare ............................................................................ 30 Adaptive Performance .......................................................................................... 31 Learning Organizations ......................................................................................... 32 Organizational Change.................................................................................................33 Diffusion of Innovation......................................................................................... 37 Leadership Challenges .......................................................................................... 39 Rationale for Changes Forcing Hospital Closures ................................................ 43 Gap in the Literature ....................................................................................................46 Summary and Conclusions ..........................................................................................47 Chapter 3: Research Method ..............................................................................................49 Research Question .......................................................................................................49 Research Method and Rationale ..................................................................................50 Research Design and Rationale ...................................................................................51 Role of the Researcher .................................................................................................51 Research Participant Selection Logic ..........................................................................53 Instrumentation ............................................................................................................53 Procedures for Recruitment, Participation, and Data Collection .................................55 Letters of Cooperation .......................................................................................... 55 Informed Consent.................................................................................................. 56 ii Data Collection Plan ............................................................................................. 56 Data Analysis Plan ................................................................................................ 58 Issues of Trustworthiness ...................................................................................... 59 Credibility ............................................................................................................
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