Pressured by industry reform, shifting demographics and budget shortfalls, rural health care is striving to reinvent itself — to become leaner, smarter and more interconnected with doctors and facilities in major population centers. But for real transformation to take place, small-town hospitals and health organizations need to attract innovative CEOs and executive leaders.

As there aren't a lot of these highly qualified leaders to go around, rural organizations must proactively market themselves to top executives. First and foremost, while these organizations may boast a small-town feel, they can't afford to act like small-town operations.

One of my clients is a 100-bed hospital in the Midwest. Despite its size, it is making continuous incremental, strategic changes to stay viable and to prevent more disruptive changes in the future. The hospital has prioritized aggressive cost-management, value-based purchasing and swift electronic health record adoption. It has gone out of its way to communicate with civic leaders and stakeholders about why and how it is making these changes. It still has a long way to go, but by showing that it can think big, the organization has been able to attract several highly qualified executives to support its strategic vision.

Other rural organizations must also be creative if they are to recruit the leaders they need for the future. What follows are suggestions for how smaller hospitals and health systems can make themselves attractive destinations for exceptional executives.

Understand Your Appeal

Rural America still has a certain Norman Rockwell allure for working professionals, and health care leaders are no exception. Many executives will sacrifice some salary and benefits in the hope for a better quality of life and a more meaningful role in patients' and employees' lives.

In my experience, a majority of candidates for rural health care leadership positions grew up in small communities, feel comfortable there and are looking to get back to their roots. Many mid- and late-career executives are looking for communities in which they can eventually retire.

They also relish the opportunity to be bigger fish in smaller ponds. Many rural facilities tend to be critical access hospitals and are often the largest employers and lifeblood of rural areas. Whether or not executives are disillusioned with larger organizations in metropolitan areas, they know they can have an outsized impact and witness tangible results in small towns.

Hospitals and health systems can use this to their advantage. It's important for them to showcase the charm and benefits of living and working in their communities. More importantly, however, they can document the significance of the organization to the community and its future. Rural health organizations can be honest about the daunting challenges they face, but demonstrate that they are committed to finding strategic solutions. This will give them a leg up in recruiting. Great leaders love challenges as long as they are in an environment where they can be successful.

Look for Leaders Who Fit

Even though an executive might be "small town" at heart, that doesn't make him or her the right person for the job. Executives who excel in rural health care must have specific skill sets and values. They need to be:

Relationship-oriented. If there is one thing rural health executives must be, it is personable. Yes, they need to be visionary and strategic, and they must understand the nuances of health care reform. But without the ability to forge strong relationships, rural executives will not succeed. They will need to form strong bonds with physician and hospital staff, board members, community leaders and even patients. Top executives for small hospitals are the face of the organization, each and every day, and need to be completely comfortable in that role.

Good listeners. Especially in a new quality-driven health care environment in which the patient voice is crucial, listening skills are essential. One of the executive's key roles will be making rounds and visiting departments to learn what's working and what isn't.

Physician-friendly. Rural CEOs and leaders need to get to know physicians personally (do they hike, ski, garden?) and meet them on their turf — in their offices or outreach clinics. Especially in health care's new era, physicians will take a larger and more strategic role in the direction of their organization. Executives — some of whom are MDs themselves — need to connect with doctors and know how to recruit good ones.

Board-friendly.In rural health care, board members are community members and often friends and neighbors. They are passionate and feel a sense of ownership in their governance responsibility. Executives need to embrace this.

Part of the community. In small communities, people expect participation. Whether through the Rotary club, school board, congregation, charity or committee, the executive needs to serve the community beyond his or her day job.

These qualities often can be spotted in the first five minutes of an interview, and rural hospital leaders definitely should make them a priority as they assess, interview and thoroughly vet leadership candidates.

Act Big

Creative rural hospitals and health systems are making themselves attractive to experienced executives by not acting like traditional, small-town operations. They're striving to be on the cutting edge of health care reform as well as new technologies and trends. They are emphasizing quality outcomes, coordinated care, cost-management, and physician relationships and integration. They understand that these initiatives will enhance their ability to succeed in the future and to compete for talented staff, physicians and executives.

We recently conducted a CEO search for a critical access hospital that had transformed itself into a state-of-the-art, integrated health care system. It boasted, for example, new surgical suites, advanced life-support ambulance services and diverse senior housing. It employed a large, multispecialty physician group and had eye and heart clinics on campus as well.

These transformations weren't without financial investment, but were essential for the hospital to keep up with the times and remain viable. Not surprisingly, there was no shortage of qualified candidates interested in becoming the new CEO and, ultimately, the hospital selected a strong leader whose vision and enthusiasm matched that of the organization.

Here are a few ways that rural organizations can act big:

Partner and align. While there are still independent rural hospitals out there, many have chosen to partner with other organizations facing similar challenges or align with larger systems headquartered in regional hubs or major cities. While hospitals obviously sacrifice autonomy in such situations, these affiliations can provide rural facilities with critical resources and funding. In most cases, the organization can keep its core mission and values intact.

For executives, partnerships can present a best-of-both-worlds opportunity. They get the small-town attributes they're looking for with the benefits of being associated with a larger network or system — greater opportunities for career development and mobility, for example. If they choose, they can take on larger responsibilities and maintain a high profile among their peers.

While affiliations typically are driven by economics and the need to meet patients' needs, rural hospitals and facilities should not overlook their importance in recruiting top executives.

Embrace technology. Rural organizations are turning to technology to stay solvent and address the needs of patients and communities. Technology can be a recruiting tool, too. Executives who see that small-town facilities are committed to investing in the latest medical equipment or expanding telemedicine services (often connecting them to physicians and experts at major health centers in the United States or even around the globe) will be impressed. On the other hand, few dynamic leaders will risk moving to a rural locale if it means becoming out of touch or falling behind peers in terms of professional sophistication. 

Understand funding and finance. Access to capital often comes with partnering with a larger system, but I've seen plenty of independent hospitals that were strategically and technologically progressive on a modest budget. Many rural hospitals are steering clear of major bricks-and-mortar projects in favor of investments in people and technology. Others have taken full advantage of the American Recovery and Reinvestment Act of 2009 to implement electronic medical records and meet Phase 1 of the meaningful use requirements. Regardless of the era, government funding is often a critical way that rural facilities can sustain and improve themselves.

The Best of Both Worlds for Executives

Rural hospitals live in a fee-for-service world while trying to innovate and move to value-based and shared-risk systems of reimbursement. Executive candidates will understand this tenuous situation and even embrace the challenges as long as they know the organization is dealing with them proactively and creatively.

Despite the many issues facing rural health care organizations, they can still be an attractive career option for executives. Rural hospitals and health systems need to separate themselves from the pack and demonstrate that, though small, they are thinking big and reinventing their futures.

Beth A. Nelson is a consultant for the executive search firm Witt/Kieffer, based in Oak Brook, Ill.