Small hospitals form a vital part of the health care safety net, serving communities that would often otherwise lack acute care. It is, therefore, important to understand how strategies unfold in these organizations. We used semistructured interviews to ask chief executive officers (CEOs) of seven small hospitals in Pennsylvania how they viewed their competitive environments and how their strategies evolved. Systematic semi-inductive analyses of these data reveal two major themes. First, CEOs of small hospitals perceive highly dynamic and hostile environments but do not stress complexity. Second, continual negotiations with key stakeholders facilitate the translation of CEOs' insights into organizational strategies.
Rebecca Wells, PhD, is Assistant Professor, Department of Health Policy and Administration, College of Health and Human Development, Pennsylvania State University, University Park
Shoou-Yih Daniel Lee, PhD, is Assistant Professor, Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill
Jennifer McClure, M.S., Data Analyst at Health Data Management Solutions, Inc. in Cleveland, Ohio
Larry Baronner, MA, is Critical Access Hospital Coordinator, Pennsylvania Office of Rural Health, University Park
Lisa Davis, MHA, is Director, Pennsylvania Office of Rural Health, University Park