Strategies for a successful collaboration between a rural hospital and an academic medical centre

Rural hospitals are facing unprecedented financial challenges in the United States. The many factors contributing to the economic headwinds for rural hospitals result in reduced clinical services offered in local communities. Affiliations, mergers and acquisitions are a path for rural facilities to keep their doors open. Maintaining independence as a rural hospital by employing an affiliation approach with a larger health system can be a sustainable path under the right circumstances. This paper outlines a successful 12-year affiliation between a critical access hospital (CAH) and an academic medical centre (AMC) in Oregon. This paper outlines the underlying structure and governance of the collaboration, important management approaches, lessons learned and the results over the life of the affiliation. The results for the CAH include the growth of annual ambulatory visits from 15,000 to 131,000, adding 430 new employees, and increasing the total annual operating revenue from US$51m to US$193m. The results for the AMC include the development of an innovative joint venture rural cancer centre, the growth of rural graduate medical education rotations, and expanding clinical department faculty who work in a rural community setting. Enhancing health care in underserved areas aligns with the AMC’s statewide mission to serve all Oregonians as the AMC. There have been significant benefits to patients by increasing access to speciality services locally, including reducing miles travelled for cancer care. Our case study demonstrates that an affiliation structure between a CAH and an AMC can be a sustainable and beneficial approach to improving access to quality health care in rural communities and can strengthen the financial performance of both organisations.