Environmental Responses in Small Rural Hospitals*

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Abstract
Major environmental forces are placing increased pressure on community small and rural hospitals to provide access to medical care in rural communities and to survive as free standing non-profit community institutions. This survey of chief executive officers of small and rural hospitals in two states examines their perceptions of their institution's environment and the degree to which multi-institutional arrangements are seen as an organizational response to a changing environment. Major differences among small and rural hospitals are explored.