Date of Award

Spring 4-27-2022

Document Type

Dissertation (799 registration)

Degree Name

Doctor of Education in Educational Leadership


Graduate Studies

Committee Chair

Ximena Suarez-Sousa


leadership, competency, leadership development, healthcare administration


Rural healthcare facilities, which include critical access hospitals, are vulnerable to closure due to workforce shortages, low patient volumes, challenging payer and patient populations, and geographic isolation. Additionally, many rural communities entered the COVID-19 pandemic understaffed, under-serviced, facing inadequate healthcare infrastructures, and with limited clinical resources and equipment. This exploratory research aimed to measure the leadership competencies identified by the American College of Healthcare Executives (ACHE) of healthcare leaders working in rural hospitals and clinics within the Midwest. Having expert leadership skills and competencies can significantly impact how an organization succeeds, both for the patients, staff, and community. In contrast, novice leadership has the potential to heighten stressors, such as staff turnover, resource allocation, and patient outcomes. Utilizing Benner’s (1982) From Novice to Expert theory, the following research question was formulated: What strengths and weaknesses do healthcare leaders perceive themselves to have in the competency domains identified by the ACHE? Per the ACHE, the competency domains have been identified as: 1) Communication and Relationship Management; 2) Leadership; 3) Professionalism; 4) Knowledge of the Healthcare Environment; and 5) Business Skills and Knowledge. The questionnaire was emailed to 310 Midwest healthcare leaders employed at either critical access hospitals or rural health clinics. A total of 94 participants completed the questionnaire in its entirety, for a 30.32% return rate. With an average of 23.90 years of working experience, mean values indicated that participants perceived their knowledge in Professionalism as the highest, while Business Skills and Knowledge had the lowest mean rating. Tentative benchmarking data based on mean and standard deviation values showed a progression of skill development between those with an associate and bachelor’s degree compared to those with a master’s and doctoral degree, thus following Benner’s (1982) From Novice to Expert theory. The results of this study provide rural health organizations in the Midwest with data to either assess and update leadership development opportunities and/or serves as a starting point to identify areas of focus. Furthermore, graduate healthcare administration programs can utilize the data for program evaluation to ensure the curriculum meets the needs of today’s healthcare leaders.



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