Abstract
Small rural hospitals, categorized as critical access hospitals (CAHs), are essential to the provision of health care in rural areas of the United States. Critical access hospitals, however, are faced with numerous challenges to their survival that are unique to their role as a rural health care provider. One of the most significant of these challenges involves the retention of well-qualified chief executive officers (CEOs). Following an assessment of the negative implications associated with CEO turnover, the study utilizes survey data obtained from CAHs experiencing CEO turnover to suggest strategies that can be implement by CAH governing board to retain CEO leadership and mitigate the negative impact of CEO turnover. A key issue identified by the authors involves the critical role played by CEO-board relationships and the need for board leadership to create a culture and environment that promotes a strong working relationship and clear expectations between the CAH board and CEO.