PHOENIX — On Day 2 of the Rural Health Care Leadership Conference, keynote speaker Pamela Knecht challenged attendees to rethink the governance skills suitable for today’s increasingly integrated health care dynamic. In what would ideally be a “continuum of care,” she said, leaders must work more collaboratively throughout their industries and democratically within their organizations to truly integrate their services.

Knecht may have been this close to preaching to the choir — rural hospitals are all but forced to adopt collaborative mindsets and think outside the box these days. Richard Cooper, chair of the National Healthcare Practice Group of the law firm McDonald Hopkins, noted that rural trustees tend to be fiercely invested in their hospitals’ operations and are no strangers to “rolling up their sleeves and getting hands-on” with their duties.

“Rural board members are much more willing [than their non-rural counterparts] to get involved,” Cooper said. “Once a problem has been identified, that characteristic of a rural board can actually be an asset to getting it solved.”

John Solheim, CEO of Cuyuna Regional Medical Center, Crosby, Minn., agrees. “[Rural leaders’] passion of community permeates everything,” he said. “Their communities depend on their being viable.”

Independent hospitals are vulnerable, but that doesn’t mean that selling or merging are the only options. There is, as Knecht advised, the chance for community integration.

Catherine Ballard, a trustee at Ivinson Memorial Hospital. Laramie, Wyo., has experienced the benefits of this integration firsthand. Her 100-bed hospital formed an affiliation with a larger care center in her isolated community (it’s 50 miles from another town) to help attract doctors, among other supportive needs.

“We’re about seven doctors short now, and we’re having trouble — like every small community — with recruiting enough physicians, so the other hospital is helping us with that,” she said. “We’ve gotten help with training for nursing leadership; we’ve gotten help with some of the IT stuff. There isn’t any area we haven’t gotten help with, really.”

Solheim offered up a case study of how his critical access hospital collaborated with another local CAH — once a competitor — to ultimately increase its recruitment clout, consistency of care and myriad other joint ventures that benefited them both. Through joint branding and plenty of communication, these independent hospitals maintained the power to fend off threats. Solheim notes that by setting aside competing agendas and “not sweating the small stuff,” rural hospitals can truly maintain their strength and viability.

“The more integrated you are, the more independent you are,” Solheim explained.

For those rural hospital leaders interested in scoping out such a partnership, it’s important to be realistic, communicative and, chiefly, committed, Cooper said.

“These types of transactions die because of lack of momentum,” he said. “If the institution doesn’t support management and the board and give it the resources and, more importantly, the support and time to make it happen, it generally doesn’t happen.”