Abstract
There is a brewing rural healthcare crisis in the United States. Small rural hospitals are being forced to close departments or the entire hospital because they are reimbursed less than what it costs to deliver care in rural areas. Healthcare providers (HCPs) experience these closures and other evolving healthcare policy changes as a VUCA (volatile, uncertain, complex, and ambiguous) work environment. I sought to examine how HCPs working in Critical Access Hospitals (CAHs), a specific type of small rural hospital, in the Pacific Northwest (PNW) navigate changing healthcare policies, cope with the challenges and inadequacies inherent in rural healthcare, find meaning in their work, and sustain their well-being. I used a generic research design to guide the study from data collection via 26 semi-structured interviews to inductive thematic data analysis. The key findings are that the current VUCA healthcare environment exacerbates rural healthcare challenges and that two important considerations have been missing from the literature on addressing the rural healthcare crisis. The first is that HCPs need a voice and agency in both clinical and operational decisions as they are being made in response to evolving policy changes. The second, and what was an unexpected finding from this dissertation study, is that the HCP’s voice needs to be in collaboration with a relational organizational leader. Together, the HCP and the leader can develop proactive actions to counter pressures on the rural healthcare system and advocate for supportive funding at the state and federal levels. These collaborative efforts are associated with greater stability and financial viability for CAHs, as well as improved well-being for HCPs working in CAHs in the PNW.