CAHs are essential to the maintenance of the rural health care core and safety-net of providers for geographically isolated areas. As the operational and strategic head responsible for daily hospital management, CAH chief executive officers (CEOs) face a number of growing and persistent challenges from evolution in care delivery to technological advancements that demand more of their executive roles. However, there is little research examining the leadership practices of CAH executives and no research that we are aware of examining practices of CEOs operating in more challenging environments.

The objective of this study was to identify best practices related to tasks of daily operation, forecasting, and community health outcomes and to craft advice for other CAH CEOs. In this study, we examine the perspectives and experiences of CEOs who lead CAHs with a low risk of financial distress despite their operating environment. Participants were asked to describe their experiences with financial and quality issues, leadership roles, performance measurement, policy challenges, and community health.