The key variables health care executives consider when altering services in non-profit short-term acute care hospitals

Health care executives face a multitude of challenges and changes on a daily basis. Health care reform and the Accountable Care Act will require executives to increase the value of the services offered by hospitals to insurance companies and patients. The literature search identified 11 key variables executives consider when altering services. The 11 variables included Staffing, Quality, Key Stakeholder Relationships, Wellness of Community, Finance, Mission, Regulatory, Market Share and Competition, Corporate Structure, Strategic Positioning, and Philanthropy.;This research study conducted a quantitative survey of the entire population of top health care executives in Ohio non-profit short-term acute care hospitals. In addition, qualitative individual depth interviews of 48 top executives at 13 hospitals were conducted by the researcher. A mixed methods approach was utilized to analyze the data from the survey and interviews. The study examined the key variables and the level of importance of the key variables utilized by health care executives in their decision-making process to alter services comparing urban hospitals to rural designated critical access hospitals, urban hospitals to rural non-critical access hospitals, and rural designated critical access hospitals to rural non-critical access hospitals.;The research study determined that there was not a significant difference in the variables considered by health care executives when altering services between the hospital classifications. However, there was a statistically significant difference in the level of importance of the key variables considered by executives when altering services between the hospital classifications, specifically between rural designated critical access and rural non-critical access hospitals. Finance was given a higher priority by executives at rural designated critical access hospitals while executives at rural non-critical access hospitals placed a higher level of importance on Staffing, Quality, Key Stakeholder Relationships, Market Share and Competition, and Strategic Positioning. The qualitative interviews were consistent with the quantitative results with the one exception being the level of importance placed on the key variables when altering services at urban hospitals as compared to rural designated critical access hospitals. The interviews indicated urban hospitals placed a much higher level of importance on Strategic Positioning, Key Stakeholder Relationships, and Market Share and Competition, as compared to Finance and Regulatory for rural designated critical access hospitals.;An important finding of the research study is that the issue of independence or being part of a system should be addressed along with assessing the hospital's financial situation prior to altering services. This is in part due to the time and resources required to alter services and the long-term organizational structure and financial status will greatly impact altering services. In addition, the proper parameters should be established prior to embarking on altering services particularly if the organization's financial situation is a high concern. Addressing the long-term corporate structure and establishing appropriate and necessary financial parameters, should facilitate communication and the establishment of realistic expectations from key stakeholders as it pertains to altering important services in the future.