A phenomenological case study exploring rural hospital employee motivation.


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American rural hospitals are in the midst of an unprecedented closure crisis. Historically low-volume, remote hospitals have survived on tax revenue and government programs; however, recent cuts in government funding and declining local property values are forcing many organizations to close. In remote communities located an hour or more away from the nearest clinic or trauma center, hospital closures leave residents with limited, and in some cases, no access to healthcare. Rankin County Hospital District (RCHD) is located in Rankin, TX, a town of 800 residents in rural West Texas. Three years ago, RCHD was on the verge of falling victim to the rural hospital crisis. A closure would have devastated the community. Not only would residents lose access to medical care, but as one of the town’s leading employers, over 100 people would lose their job. To increase revenue, RCHD began offering new services. As intended, these new services increased profitability; however, staffing these new positions has become a problem. One group of employees has taken on most of the new responsibilities, while the other group is content in their current roles. As the organization continues to grow, the likelihood of sustaining current momentum is low without contributions from the entire staff. To ensure continued progress and meet employee needs, this study examined which factors contribute to employee motivation at RCHD. Existing research provides a strong base for understanding employee motivation at RCHD. However, current healthcare employee motivation studies take place in large health systems with thousands of employees. While motivating factors among healthcare employees may be similar across regions regardless of organization size, no rural healthcare employee motivation research exists. Following a phenomenological case study design, RCHD employees representing all twelve departments completed a paper-based survey and participated in one-on-one interviews. Motivation trends surfaced in the areas of leadership, local economy, employee age, job satisfaction, and training requirements. Existing motivation theories, including Maslow’s Needs Hierarchy, Herzberg’s Two-Factor Theory, and Vroom’s Expectancy Theory, provided a solid foundation in examining the findings, exploring implications, and developing a clearer understanding of rural healthcare employee motivation.



Rural hospitals. Employee motivation. Healthcare employees. Rankin County Hospital District. Hospital closure crisis.